[Variability of management for patients hospitalized with 2009 A/H1N1 influenza in three Israeli hospitals].

OBJECTIVES: To assess uniformity of criteria for hospitalization and management of inpatients with documented 2009 A/H1N1 influenza, at a time when national guidelines for management were issued by the public health authorities. METHODS: This was a prospective observational cohort study. We included all adults with laboratory-confirmed pandemic 2009 A/H1N1 influenza in three hospitals in central Israel admitted between 22/7/2009 and 15/2/2010. We compared baseline data, results and treatment management between the three hospitals. Chi-square, ANOVA and Kruskal-WalLis tests were performed. RESULTS: Overall, 496 patients with documented 2009 A/H1N1 influenza were included; the mean age was 44 years (range 19-93). Of all the patients sampled, PCR for influenza was positive in 21.2% [178/840], 27.4% [124/453] and 18.6% [194/1043] in the three hospitals. Differences between hospitals in baseline patient characteristics were few. Significant differences were observed with regard to disease characteristics at admission, including temperature, respiratory symptoms, hypoxia, pulmonary infiltrates (33.7% [60/178], 19.4% [24/124] and 38.7% [75/194]), all influenza complications and severity of illness score (p < 0.05 for all). Differences were observed with regard to oseltamivir treatment, ranging from 79.5% to 98.9% of inpatients. Antibiotic treatment was common (overall 71%) but differences between hospitals were observed with regard to the antibiotic regimens used. The ratio of infectious disease physicians to hospital-bed ratio was low and variable (0.35, and 0.35 per 100 beds). CONCLUSIONS: There was significant variability between hospitals in the hospitalization and management of patients hospitalized with 2009 A/H1N1 influenza.

Benefit of early treatment with oseltamivir in hospitalized patients with documented 2009 influenza A (H1N1): retrospective cohort study.

BACKGROUND: We assessed the association between early oseltamivir treatment and influenza complications in hospitalized patients. METHODS: A retrospective cohort study, including adults with laboratory-confirmed 2009 influenza A (H1N1) in three hospitals in Israel, was performed between July 2009 and January 2010, when admission was limited to high-risk patients. We compared patients treated with oseltamivir early versus late (>48 h after symptom onset). We analysed risk factors for complications, defined as radiographic pneumonia, hypoxia, mechanical ventilation, intensive care unit admission, haemodynamic support or in-hospital death. Risk factors for complications on univariate analysis were entered into a multivariable logistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (CI) are reported. RESULTS: Four hundred and forty-nine inpatients treated with oseltamivir were included, 189 (42.1%) of whom were treated early. Influenza complications occurred significantly more frequently among patients treated late with oseltamivir [150/260 (57.7%) versus 67/189 (35.4%), P < 0.001]. Late oseltamivir remained significantly associated with complications in the adjusted analysis (OR 2.37, 95% CI 1.52-3.70). Other independent risk factors included dyspnoea, disease severity on admission, lower sodium and treatment at one hospital; rhinorrhoea was protective. In an analysis adjusted for the propensity for early treatment the association remained significant (OR 2.21, 95% CI 1.41-3.46). Initiation of oseltamivir >48 h after admission was associated with a higher rate of complications documented after admission (OR 4.09, 95% CI 1.55-10.80). Severe complications (excluding hypoxia and uncomplicated pneumonia) occurred more frequently with late oseltamivir (adjusted OR 3.28,95% CI 1.56-6.89). CONCLUSIONS: Initiation of oseltamivir within 48 h of symptom onset was associated with fewer complications in patients hospitalized with 2009 influenza A (H1N1).