TY - JOUR
T1 - Impact of early oseltamivir treatment on outcome in critically ill patients with 2009 pandemic influenza A
AU - Rodríguez, Alejandro
AU - Díaz, Emili
AU - Martín-Loeches, Ignacio
AU - Sandiumenge, Alberto
AU - Canadell, Laura
AU - Díaz, Juan J.
AU - Figueira, Juan C.
AU - Marques, Asunción
AU - Álvarez-Lerma, Francisco
AU - Vallés, Jordi
AU - Baladín, Bárbara
AU - García-López, Fernando
AU - Suberviola, Borja
AU - Zaragoza, Rafael
AU - Trefler, Sandra
AU - Bonastre, Juan
AU - Blanquer, José
AU - Rello, Jordi
PY - 2011/5/1
Y1 - 2011/5/1
N2 - Objectives: The impact of oseltamivir on mortality in critically ill patients with 2009 pandemic influenza A (2009 H1N1) is not clear. The main objective of this study was to investigate the relationship between the timing of antiviral administration and intensive care unit (ICU) outcomes. Methods: Prospective, observational study of a cohort of ICU patients with confirmed 2009 H1N1 infection. Clinical data, treatment and outcome were compared between patients receiving early treatment (ET) with oseltamivir, initiated within 2 days, and patients administered late treatment (LT), initiated after this timepoint. Multivariate analysis and propensity score were used to determine the effect of oseltamivir on ICU mortality. Results: Six hundred and fifty-seven patients were enrolled. Four hundred and four (61.5%) patients required mechanical ventilation (MV; mortality 32.6%). Among them, 385 received effective antiviral therapy and were included in the study group. All patients received oseltamivir for a median duration of 10 days (interquartile range 8-14 days). Seventy-nine (20.5%) ET patients were compared with 306 LT patients. The two groups were comparable in terms of main clinical variables. ICU length of stay (22.7±16.7 versus 18.4±14.2 days; P=0.03), hospital length of stay (34.0±20.3 versus 27.2±18.2 days; P=0.001) and MV days (17.4±15.2 versus 14.0±12.4; P=0.04) were higher in the LT group. ICU mortality was also higher in LT (34.3%) than in ET (21.5%; OR=1.9; 95% CI 1.06-3.41). A multivariate model identified ET (OR=0.44; 95% CI 0.21-0.87) as an independent variable associated with reduced ICU mortality. These results were confirmed by propensity score analysis (OR=0.44; 95% CI 0.22-0.90; P,0.001). Conclusions: Our findings suggest that early oseltamivir administration was associated with favourable outcomes among critically ill ventilated patients with 2009 H1N1 virus infection. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
AB - Objectives: The impact of oseltamivir on mortality in critically ill patients with 2009 pandemic influenza A (2009 H1N1) is not clear. The main objective of this study was to investigate the relationship between the timing of antiviral administration and intensive care unit (ICU) outcomes. Methods: Prospective, observational study of a cohort of ICU patients with confirmed 2009 H1N1 infection. Clinical data, treatment and outcome were compared between patients receiving early treatment (ET) with oseltamivir, initiated within 2 days, and patients administered late treatment (LT), initiated after this timepoint. Multivariate analysis and propensity score were used to determine the effect of oseltamivir on ICU mortality. Results: Six hundred and fifty-seven patients were enrolled. Four hundred and four (61.5%) patients required mechanical ventilation (MV; mortality 32.6%). Among them, 385 received effective antiviral therapy and were included in the study group. All patients received oseltamivir for a median duration of 10 days (interquartile range 8-14 days). Seventy-nine (20.5%) ET patients were compared with 306 LT patients. The two groups were comparable in terms of main clinical variables. ICU length of stay (22.7±16.7 versus 18.4±14.2 days; P=0.03), hospital length of stay (34.0±20.3 versus 27.2±18.2 days; P=0.001) and MV days (17.4±15.2 versus 14.0±12.4; P=0.04) were higher in the LT group. ICU mortality was also higher in LT (34.3%) than in ET (21.5%; OR=1.9; 95% CI 1.06-3.41). A multivariate model identified ET (OR=0.44; 95% CI 0.21-0.87) as an independent variable associated with reduced ICU mortality. These results were confirmed by propensity score analysis (OR=0.44; 95% CI 0.22-0.90; P,0.001). Conclusions: Our findings suggest that early oseltamivir administration was associated with favourable outcomes among critically ill ventilated patients with 2009 H1N1 virus infection. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
KW - Antiviral treatment
KW - Pneumonia
KW - Prognosis
U2 - 10.1093/jac/dkq511
DO - 10.1093/jac/dkq511
M3 - Article
SN - 0305-7453
VL - 66
SP - 1140
EP - 1149
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
IS - 5
M1 - dkq511
ER -