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Outcomes and prognostic features of patients with influenza requiring hospitalization and receiving early antiviral therapy: A Prospective Multicenter-Cohort Study.
Chest. 2015 Jul 23;
Authors: Maruyama T, Fujisawa T, Suga S, Nakamura H, Nagao M, Taniguchi K, Tsutsui K, Ihara T, Niederman MS
Abstract
Background: In Japan, routine use of early antiviral therapy for patients with influenza is standard.
Methods: Multicenter prospective cohort evaluation of hospitalized patients with laboratory-confirmed influenza to identify prognostic factors among patients receiving antiviral therapy.
Results: The population included 1345 influenza patients ( 766 pediatric and 579 adult), and excluding those < age 1(not approved for anti-viral therapy) , 97.7% (1224/1253) received antiviral therapy. Among 579 adult patients, 24 (4.1%) died within 30 days , while none of the 766 pediatric patients died. 528 of the adult patients (91.2%) had influenza A, 509 (87.9%) had a chronic underlying illness, 211 (36.4%) had radiographically confirmed pneumonia . 20 of the 24 patients who died, had pneumonia , and the etiologies were: Streptococcus pneumoniae (12.3%), Staphylococcus aureus (10.9%), including methicillin-resistant S. aureus (MRSA) (3.3%), Enterobacteriaceae (8.1%), and Pseudomonas aeruginosa (3.3%). Of these, 151 were classified as community-acquired pneumonia (CAP), and 60 as healthcare-associated pneumonia (HCAP). Inappropriate therapy was more common in HCAP than CAP ( 15.2% vs. 2%, p=0.001). Potential multidrug-resistant (MDR) pathogens were more common ( 21.7%vs 2.6%, p<0.001) in HCAP patients, particularly MRSA (10% vs 0.7%, p=0.002) and Pseudomonas aeruginosa (8.3% vs 1.3%, p=0.021). Using Cox proportional hazards modeling with prescribed independent variables, male gender, severity score, serum albumin (malnutrition), and pneumonia were associated with survival 30 -days from the onset of influenza.
Conclusions: Among the prognostic factors, malnutrition and pneumonia are amenable to medical intervention. There is an opportunity to improve empiric therapy for patients with HCAP and influenza.
Trial registration: Japan Medical Association Center for Clinical Trials JMA-IIA00123.
PMID: 26203671 [PubMed - as supplied by publisher]