Neuraminidase Inhibitors and Hospital Length of Stay: A Meta-analysis of Individual Participant Data to Determine Treatment Effectiveness Among Patients Hospitalized With Nonfatal 2009 Pandemic Influenza A(H1N1) Virus Infection

Sudhir Venkatesan, Puja R. Myles, Kirsty J. Bolton, Stella G. Muthuri, Tarig Al Khuwaitir, Ashish P. Anovadiya, Eduardo Azziz-Baumgartner, Tahar Bajjou, Matteo Bassetti, Bojana Beovic, Barbara Bertisch, Isabelle Bonmarin, Robert Booy, Victor H. Borja-Aburto, Heinz Burgmann, Bin Cao, Jordi Carratala, Tserendorj Chinbayar, Catia Cilloniz, Justin T. DenholmSamuel R. Dominguez, Pericles A.D. Duarte, Gal Dubnov-Raz, Sergio Fanella, Zhancheng Gao, Patrick Gérardin, Maddalena Giannella, Sophie Gubbels, Jethro Herberg, Peter H. Hoeger, Xiao Yun Hu, Quazi T. Islam, Mirela F. Jiménez, Gerben Keijzers, Hossein Khalili, Gabriela Kusznierz, Ilija Kuzman, Eduard Langenegger, Kamran B. Lankarani, Yee Sin Leo, Romina P. Libster, Rita Linko, Faris Madanat, Efstratios Maltezos, Abdullah Mamun, Toshie Manabe, Gokhan Metan, Auksė Mickiene, Dragan Mikić, Kristin G.I. Mohn, Maria E. Oliva, Mehpare Ozkan, Dhruv Parekh, Mical Paul, Barbara A. Rath, Samir Refaey, Alejandro H. Rodríguez, Bunyamin Sertogullarindan, Joanna Skręt-Magierło, Ayper Somer, Ewa Talarek, Julian W. Tang, Kelvin To, Dat Tran, Wendy Vaudry, Tjasa Vidmar, Paul Zarogoulidis, PRIDE Consortium Investigators, Jonathan S. Nguyen-Van-Tam

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

BACKGROUND: 

The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear. 

METHODS: 

We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded. 

RESULTS: 

We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78-.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS. 

CONCLUSIONS: 

When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.

Original languageEnglish
Pages (from-to)356-366
Number of pages11
JournalThe Journal of infectious diseases
Volume221
Issue number3
Early online date17 Jul 2019
DOIs
Publication statusPublished - 1 Feb 2020
Externally publishedYes

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  • Cite this

    Venkatesan, S., Myles, P. R., Bolton, K. J., Muthuri, S. G., Al Khuwaitir, T., Anovadiya, A. P., Azziz-Baumgartner, E., Bajjou, T., Bassetti, M., Beovic, B., Bertisch, B., Bonmarin, I., Booy, R., Borja-Aburto, V. H., Burgmann, H., Cao, B., Carratala, J., Chinbayar, T., Cilloniz, C., ... Nguyen-Van-Tam, J. S. (2020). Neuraminidase Inhibitors and Hospital Length of Stay: A Meta-analysis of Individual Participant Data to Determine Treatment Effectiveness Among Patients Hospitalized With Nonfatal 2009 Pandemic Influenza A(H1N1) Virus Infection. The Journal of infectious diseases, 221(3), 356-366. https://doi.org/10.1093/infdis/jiz152