Program Schedule

1714
Influenza antiviral agent use among adults hospitalized with community-acquired pneumonia

Session: Poster Abstract Session: Public Health
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Antiviral IDWeek poster 09_30_14_IKO-v3.pdf (276.0 kB)
  • Background: Influenza is a common cause of community-acquired pneumonia (CAP).  Data on the use of influenza antiviral treatment among patients hospitalized with all-cause CAP are limited. 

    Methods: Adults ≥18 years old hospitalized with CAP were enrolled year-round at 5 hospitals in Chicago and Nashville.  Clinicians ordered influenza tests (rapid test, direct fluorescent antigen, or polymerase chain reaction [PCR]) and prescribed antivirals per clinical judgment.  Nasopharyngeal /oropharyngeal specimens for influenza PCR testing were systematically collected for the study but results were unavailable to clinicians.  Treatment was defined as influenza antiviral agent receipt during hospitalization for any period of time.  We compared factors associated with receipt and non-receipt of treatment during influenza season (October−April in each year).

    Results: From January 2010−June 2012, we enrolled 2323 adults with CAP.  Of 1491 (64%) adults enrolled during influenza season, 180 (12%) received treatment.  Clinicians ordered influenza tests in 583 (39%) patients (96% were PCR); 37/48 (77%) with a positive result received antivirals.  Study testing revealed 100 influenza positive cases, 41 of whom received antivirals.  Compared with those who did not receive treatment, adults who received treatment were younger, admitted earlier during illness, less likely to have a comorbidity, and more likely to need intensive care unit (ICU) admission or mechanical ventilation. 

    Characteristic

      Receipt of treatment

     (n=180)

    No. (%)

    Non-receipt of  treatment

    (n=1311)

     No. (%)

    P value

    Median age (interquartile range [IQR]) years

    54 (41-66)

    58 (47-71)

    <0.01

    Median days from illness onset to admission (IQR)

    3 (2−6)

    4 (2−8)

    0.03

    Any comorbidity

    146 (81)

    1163 (89)

    <0.01

    Positive clinician-ordered influenza test/total tested

    37/129 (29)

    11/454 (2)

    <0.01

    ICU admission

    68 (38)

    242 (19)

    <0.01

    Invasive mechanical ventilation

    32/68 (47)

    59/242 (24)

    <0.01

    Conclusion: Among adults hospitalized with all-cause CAP, receipt of influenza antiviral treatment was low and associated with having a positive influenza result available to clinicians, presenting earlier in course of illness, and with severe disease.  Reasons for the underutilization of antiviral treatment warrant exploration.

    Ikwo Oboho, MD1,2, Anna M. Bramley, MPH1, Lyn Finelli, DrPH, MS1, Alicia M. Fry, MD, MPH1, Richard Wunderink, MD3, Wesley H. Self, MD, MPH4, Evan Anderson, MD3, Mark Courtney, MD3, Carlos G. Grijalva, MD, MPH5, Derek J. Williams, MD, MPH4, Sandra R. Arnold, MD6,7, Krow Ampofo, MD8, Yuwei Zhu, MD, MS4, Jonathan a. Mccullers, MD6,7, Andrew Pavia, MD, FIDSA, FSHEA8, Kathryn Edwards, MD, FIDSA4 and Seema Jain, MD, MPH1, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, (3)Northwestern University Feinberg School of Medicine, Chicago, IL, (4)Vanderbilt University School of Medicine, Nashville, TN, (5)Preventative Medicine, Vanderbilt University School of Medicine, Nashville, TN, (6)University of Tennessee Health Science Center, Memphis, TN, (7)Le Bonheur Children's Hospital, Memphis, TN, (8)University of Utah Health Sciences Center, Salt Lake City, UT

    Disclosures:

    I. Oboho, None

    A. M. Bramley, None

    L. Finelli, None

    A. M. Fry, None

    R. Wunderink, Genentech: Consultant, Consulting fee
    Crucell/Janssen/J&J: Consultant, Consulting fee

    W. H. Self, None

    E. Anderson, None

    M. Courtney, None

    C. G. Grijalva, None

    D. J. Williams, None

    S. R. Arnold, None

    K. Ampofo, None

    Y. Zhu, None

    J. A. Mccullers, None

    A. Pavia, None

    K. Edwards, Novartis: Grant Investigator and Scientific Advisor, Research grant

    S. Jain, None

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