Decreased Hospital Length of Stay With Early Administration of Oseltamivir in Patients Hospitalized With Influenza

Lin Dou; Dan Reynolds; Lindsey Wallace; John O'Horo; Rahul Kashyap; Ognjen Gajic; Hemang Yadav

doi:10.1016/j.mayocpiqo.2019.12.005

Decreased Hospital Length of Stay With Early Administration of Oseltamivir in Patients Hospitalized With Influenza

Mayo Clin Proc Innov Qual Outcomes. 2020 Apr 6;4(2):176-182. doi: 10.1016/j.mayocpiqo.2019.12.005. eCollection 2020 Apr.

Authors

Lin Dou¹, Dan Reynolds², Lindsey Wallace³, John O'Horo^{4

5}, Rahul Kashyap⁵, Ognjen Gajic⁵, Hemang Yadav⁵

Affiliations

¹ Division of Critical Care Medicine, Tianjin First Center Hospital, China.
² Department of Internal Medicine, Mayo Clinic, Rochester, MN.
³ Critical Care Independent Multidisciplinary Program, Mayo Clinic, Rochester, MN.
⁴ Division of Infectious Diseases, Mayo Clinic, Rochester, MN.
⁵ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

Abstract

Objective: To evaluate the effects of timely oseltamivir administration in patients hospitalized with seasonal influenza.

Patients and methods: We performed a single-center retrospective cohort study for hospitalized patients who tested positive for influenza between December 1, 2010, and July 1, 2014. We compared outcomes for patients who received antivirals within 48 hours of symptoms to those of patients who either received oseltamivir after 48 hours or never received oseltamivir. Hospital length of stay (LOS) and 90-day mortality were compared using Cox regression models. Antiviral administration was analyzed as a time-varying covariate.

Results: During the study period, 433 patients were hospitalized with laboratory-confirmed influenza. Of these patients, 146 (33.7%) received oseltamivir within 48 hours of symptoms, 202 (46.7%) received oseltamivir after 48 hours of symptoms, and 85 (19.6%) did not receive antivirals. Baseline characteristics were similar among these patient groups. Receiving oseltamivir within 48 hours was associated with shorter hospital LOS (5.9 days vs 7.2 days; P=.03) but no significant difference in 90-day mortality (13.7% vs 11.5%; P=.51). In a Cox regression analysis, patients who received antivirals within 48 hours had a 50% higher chance of being discharged (hazard ratio, 1.50; 95% CI, 1.14-1.98) on any given day during hospital stay.

Conclusion: In patients hospitalized with laboratory-confirmed influenza, timely administration of oseltamivir was associated with shorter hospital LOS.

Keywords: HR, hazard ratio; ICU, intensive care unit; IQR, interquartile range; LOS, length of stay; NAI, neuraminidase inhibitor; PCR, polymerase chain reaction.