Impact of early oseltamivir treatment on outcome in critically ill patients with 2009 pandemic influenza A

Alejandro Rodríguez, Emili Díaz, Ignacio Martín-Loeches, Alberto Sandiumenge, Laura Canadell, Juan J. Díaz, Juan C. Figueira, Asunción Marques, Francisco Álvarez-Lerma, Jordi Vallés, Bárbara Baladín, Fernando García-López, Borja Suberviola, Rafael Zaragoza, Sandra Trefler, Juan Bonastre, José Blanquer, Jordi Rello

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Abstract

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.
Original languageEnglish
Article numberdkq511
Pages (from-to)1140-1149
JournalJournal of Antimicrobial Chemotherapy
Volume66
Issue number5
DOIs
Publication statusPublished - 1 May 2011

Keywords

  • Antiviral treatment
  • Pneumonia
  • Prognosis

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