Increased Antiviral Treatment Among Hospitalized Children and Adults With Laboratory-Confirmed Influenza, 2010–2015

Appiah, Grace D.; Chaves, Sandra S.; Kirley, Pam Daily; Miller, Lisa; Meek, James; Anderson, Evan J.; Oni, Oluwakemi; Ryan, Patricia; Eckel, Seth; Lynfield, Ruth; Bargsten, Marisa; Zansky, Shelley; Bennett, Nancy M.; Lung, Krista; McDonald-Hamm, Christie; Thomas, Ann; Brady, Diane; Lindegren, Mary Lou; Schaffner, William; Hill, Mary; Garg, Shikha; Fry, Alicia M.; Campbell, Angela P

doi:10.1093/cid/ciw745

Cited by 33 publications

(29 citation statements)

References 11 publications

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“…Late antiviral treatment also appears to be an important confounder between obesity and influenza severity, as the likelihood of severe disease increased among obese individuals after adjustment for treatment in all models. These findings add to previous observations of the connection between antiviral treatment and obesity; a 2016 paper examined antiviral treatment among hospitalized patients from 2010 to 2015 and found that individuals with high risk conditions, including morbid obesity, were significantly more likely than non‐obese individuals to receive antivirals; however, the 2016 study did not evaluate timing of therapy …”

Section: Discussionmentioning

confidence: 61%

“…These findings add to previous observations of the connection between antiviral treatment and obesity; a 2016 paper examined antiviral treatment among hospitalized patients from 2010 to 2015 and found that individuals with high risk conditions, including morbid obesity, were significantly more likely than non-obese individuals to receive antivirals; however, the 2016 study did not evaluate timing of therapy. 23 This study took place at hospitals in Detroit, Michigan, a city with high levels of obesity and poverty. 24 As expected in hospitals in an underserved area, many participants had self-reported poor health in addition to the need for special medical equipment and physical, mental, or emotional limitations.…”

Section: Discussionmentioning

confidence: 99%

“…In all models, late antiviral treatment was associated with increased odds of LRD (OR: 3.9 [1.1,15.9] in fully adjusted model). After adjustment for treatment timing, the odds of ICU admission (OR: 6.4 [0.8,58.2] to 7.9 [0.9, 87.1]) and LRD (OR: 3.3 [0.5,23.5] to 4.0 [0.6, 35.0]) associated with morbid obesity increased. Obese individuals were treated with antivirals earlier than others.Late antiviral treatment was associated with severe influenza in the hospital.…”

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confidence: 99%

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The impact of obesity and timely antiviral administration on severe influenza outcomes among hospitalized adults

Segaloff

Evans

Arshad

et al. 2017

Journal of Medical Virology

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Obesity was identified as a risk factor for severe influenza during the 2009 influenza A(H1N1)pandemic, but evidence of this association has been mixed since. Post-pandemic antiviral treatment guidelines may have increased antiviral treatment among obese individuals. A prospective study of adults hospitalized with laboratory-confirmed influenza in Detroit, Michigan in 2011-2012 and 2012-2013 was conducted. Patient information was collected from interviews and medical chart abstraction. Obese (BMI ≥ 30) and non-obese (BMI < 30) participants were compared. Late antiviral treatment (>2 days from symptom onset), obesity (30 ≤ BMI < 40), and morbid obesity (BMI ≥ 40) were evaluated as predictors of lower respiratory tract disease (LRD), ICU admission, and length of stay (LOS) using logistic regression and inverse probability weighted models. Forty-eight participants were included in the study after exclusions and all patients received antiviral treatment. Participants who were obese were significantly more likely to have a cough and to take steroids than non-obese participants, and had a shorter time from hospital admission to antiviral treatment (median time from admission to treatment of 0 days for obese patients and 1 day for non-obese patients [P = 0.001]). In all models, late antiviral treatment was associated with increased odds of LRD (OR: 3.9 [1.1,15.9] in fully adjusted model). After adjustment for treatment timing, the odds of ICU admission (OR: 6.4 [0.8,58.2] to 7.9 [0.9, 87.1]) and LRD (OR: 3.3 [0.5, 23.5] to 4.0 [0.6, 35.0]) associated with morbid obesity increased. Obese individuals were treated with antivirals earlier than others. Late antiviral treatment was associated with severe influenza in the hospital.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The impact of obesity and timely antiviral administration on severe influenza outcomes among hospitalized adults

Segaloff

Evans

Arshad

et al. 2017

Journal of Medical Virology

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“…A previous study of .30 000 admissions due to influenza (including .6000 children) revealed similar rates of timely administration of anti-influenza medications regardless of duration of illness preceding hospitalization. 17 Differences in care pathways between individual hospitals were unavailable from the database and may have accounted for differences in our outcomes. However, we found that differences in treating hospitals accounted for 0% to 2.3% of variance in all outcomes, which suggests any variations due to hospital-level factors, such as care pathways, did not have significant influence on the outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 Most children hospitalized with influenza, however, do not receive anti-influenza medications in a timely fashion. 17,18 Furthermore, evidence regarding efficacy of anti-influenza medications among CMC is limited.…”

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confidence: 99%

Early Use of Anti-influenza Medications in Hospitalized Children With Tracheostomy

et al. 2019

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Assessment of Temporal Patterns and Patient Factors Associated With Oseltamivir Administration in Children Hospitalized With Influenza, 2007-2020

et al. 2022

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ImportanceOseltamivir therapy is recommended for all pediatric inpatients with influenza, particularly those with high-risk conditions, although data regarding its uptake and benefits are limited.ObjectiveTo describe temporal patterns and independent patient factors associated with the use of oseltamivir and explore patterns in resource use and patient outcomes among children hospitalized with influenza.Design, Setting, and ParticipantsThis multicenter retrospective cross-sectional study was conducted at 36 tertiary pediatric hospitals participating in the Pediatric Health Information System in the US. A total of 70 473 children younger than 18 years who were hospitalized with influenza between October 1, 2007, and March 31, 2020, were included.ExposuresHospitalization with a diagnosis of influenza.Main Outcomes and MeasuresThe primary outcome was the use of oseltamivir, which was described by influenza season and by hospital. Patient factors associated with oseltamivir use were assessed using multivariable mixed-effects logistic regression models. Secondary outcomes were resource use (including antibiotic medications, chest radiography, supplemental oxygen, positive pressure ventilation, central venous catheter, and intensive care unit [ICU]) and patient outcomes (length of stay, late ICU transfer, 7-day hospital readmission, use of extracorporeal membrane oxygenation, and in-hospital mortality), which were described as percentages per influenza season.ResultsAmong 70 473 children hospitalized with influenza, the median (IQR) age was 3.65 (1.05-8.26) years; 30 750 patients (43.6%) were female, and 39 715 (56.4%) were male. Overall, 16 559 patients (23.5%) were Black, 36 184 (51.3%) were White, 14 133 (20.1%) were of other races (including 694 American Indian or Alaska Native [1.0%], 2216 Asian [3.0%], 372 Native Hawaiian or Pacific Islander [0.5%], and 10 850 other races [15.4%]), and 3597 (5.1%) were of unknown race. A total of 47 071 patients (66.8%) received oseltamivir, increasing from a low of 20.2% in the 2007-2008 influenza season to a high of 77.9% in the 2017-2018 season. Use by hospital ranged from 43.2% to 79.7% over the entire study period and from 56.5% to 90.1% in final influenza season studied (2019-2020). Factors associated with increased oseltamivir use included the presence of a complex chronic condition (odds ratio [OR], 1.42; 95% CI, 1.36-1.47), a history of asthma (OR, 1.31; 95% CI, 1.23-1.38), and early severe illness (OR, 1.19; 95% CI, 1.13-1.25). Children younger than 2 years (OR, 0.81; 95% CI, 0.77-0.85) and children aged 2 to 5 years (OR, 0.83; 95% CI, 0.79-0.88) had lower odds of receiving oseltamivir. From the beginning (2007-2008) to the end (2019-2020) of the study period, the use of antibiotic medications (from 74.4% to 60.1%) and chest radiography (from 59.2% to 51.7%) decreased, whereas the use of oxygen (from 33.6% to 29.3%), positive pressure ventilation (from 10.8% to 7.9%), and central venous catheters (from 2.5% to 1.0%) did not meaningfully change. Patient outcomes, including length of stay (median [IQR], 3 [2-5] days for all seasons), readmissions within 7 days (from 4.0% to 3.4%), use of extracorporeal membrane oxygenation (from 0.5% to 0.5%), and in-hospital mortality (from 1.1% to 0.8%), were stable from the beginning to the end of the study period.Conclusions and RelevanceIn this cross-sectional study of children hospitalized with influenza, the use of oseltamivir increased over time, particularly among patients with high-risk conditions, but with wide institutional variation. Patient outcomes remained largely unchanged. Further work is needed to evaluate the impact of oseltamivir therapy in this population.

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Increased Antiviral Treatment Among Hospitalized Children and Adults With Laboratory-Confirmed Influenza, 2010–2015

Cited by 33 publications

References 11 publications

The impact of obesity and timely antiviral administration on severe influenza outcomes among hospitalized adults

The impact of obesity and timely antiviral administration on severe influenza outcomes among hospitalized adults

Early Use of Anti-influenza Medications in Hospitalized Children With Tracheostomy

Assessment of Temporal Patterns and Patient Factors Associated With Oseltamivir Administration in Children Hospitalized With Influenza, 2007-2020

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