Benefit of early oseltamivir therapy for adults hospitalized with influenza A: an observational study

Authors

Nathaniel M. Lewis, Influenza Division, National Center for Immunization and Respiratory Diseases, CDC.
Elizabeth J. Harker, Influenza Division, National Center for Immunization and Respiratory Diseases, CDC.
Lauren B. Grant, Influenza Division, National Center for Immunization and Respiratory Diseases, CDC.
Yuwei Zhu, Vanderbilt University Medical Center, Nashville, Tennessee.
Carlos G. Grijalva, Vanderbilt University Medical Center, Nashville, Tennessee.
James D. Chappell, Vanderbilt University Medical Center, Nashville, Tennessee.
Jillian P. Rhoads, Vanderbilt University Medical Center, Nashville, Tennessee.
Adrienne Baughman, Vanderbilt University Medical Center, Nashville, Tennessee.
Jonathan D. Casey, Vanderbilt University Medical Center, Nashville, Tennessee.
Paul W. Blair, Vanderbilt University Medical Center, Nashville, Tennessee.
Ian D. Jones, Vanderbilt University Medical Center, Nashville, Tennessee.
Cassandra A. Johnson, Vanderbilt University Medical Center, Nashville, Tennessee.Follow
Adam S. Lauring, University of Michigan, Ann Arbor, Michigan.
Manju Gaglani, Baylor Scott & White Health, Texas.
Shekhar Ghamande, Baylor College of Medicine, Temple, Texas.
Cristie Columbus, Baylor College of Medicine, Temple, Texas.
Jay S. Steingrub, Baystate Medical Center, Springfield, Massachusetts.
Nathan I. Shapiro, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Abhijit Duggal, Cleveland Clinic, Cleveland, Ohio.
Laurence W. Busse, Emory University, Atlanta, Georgia.
Jamie Felzer, Emory University, Atlanta, Georgia.
Matthew E. Prekker, Hennepin County Medical Center, Minneapolis, Minnesota.
Ithan D. Peltan, University of Utah, Salt Lake City, Utah.
Samuel M. Brown, University of Utah, Salt Lake City, Utah.
David N. Hager, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Michelle N. Gong, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.
Amira Mohamed, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.
Matthew C. Exline, The Ohio State University, Columbus, Ohio.Follow
Akram Khan, Oregon Health & Science University, Portland, Oregon.Follow
Catherine L. Hough, Oregon Health & Science University, Portland, Oregon.
Jennifer G. Wilson, Stanford University School of Medicine, Stanford, California.
Jarrod Mosier, University of Arizona, Tucson, Arizona.

Document Type

Article

Publication Title

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Abstract

BACKGROUND: clinical guidelines recommend initiation of antiviral therapy as soon as possible for patients hospitalized with confirmed or suspected influenza. METHODS: A multicenter US observational sentinel surveillance network prospectively enrolled adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza at 24 hospitals during October 1, 2022-July 21, 2023. A multivariable proportional odds model was used to compare peak pulmonary disease severity (no oxygen support, standard supplemental oxygen, high-flow oxygen/non-invasive ventilation, invasive mechanical ventilation, or death) after the day of hospital admission among patients starting oseltamivir treatment on the day of admission (early) versus those who did not (late or not treated), adjusting for baseline (admission day) severity, age, sex, site, and vaccination status. Multivariable logistic regression models were used to evaluate the odds of intensive care unit (ICU) admission, acute kidney replacement therapy or vasopressor use, and in-hospital death. RESULTS: A total of 840 influenza-positive patients were analyzed, including 415 (49%) who started oseltamivir treatment on the day of admission, and 425 (51%) who did not. Compared with late or not treated patients, those treated early had lower peak pulmonary disease severity (proportional aOR: 0.60, 95% CI: 0.49-0.72), and lower odds of intensive care unit admission (aOR: 0.24, 95% CI: 0.13-0.47), acute kidney replacement therapy or vasopressor use (aOR: 0.40, 95% CI: 0.22-0.67), and in-hospital death (aOR: 0.36, 95% CI: 0.18-0.72). CONCLUSION: Among adults hospitalized with influenza, treatment with oseltamivir on day of hospital admission was associated reduced risk of disease progression, including pulmonary and extrapulmonary organ failure and death.

DOI

10.1093/cid/ciae584

Publication Date

11-28-2024

Identifier

39607747 (pubmed); 10.1093/cid/ciae584 (doi); 7912192 (pii)

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