Oboho Ikwo K, Bramley Anna, Finelli Lyn, Fry Alicia, Ampofo Krow, Arnold Sandra R, Self Wesley H, Williams Derek J, Courtney D Mark, Zhu Yuwei, Anderson Evan J, Grijalva Carlos G, McCullers Jonathan A, Wunderink Richard G, Pavia Andrew T, Edwards Kathryn M, Jain Seema
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
Open Forum Infect Dis. 2016 Dec 27;4(1):ofw254. doi: 10.1093/ofid/ofw254. eCollection 2017 Winter.
Data on oseltamivir treatment among hospitalized community-acquired pneumonia (CAP) patients are limited.
Patients hospitalized with CAP at 6 hospitals during the 2010-2012 influenza seasons were included. We assessed factors associated with oseltamivir treatment using logistic regression.
Oseltamivir treatment was provided to 89 of 1627 (5%) children (<18 years) and 143 of 1051 (14%) adults. Among those with positive clinician-ordered influenza tests, 39 of 61 (64%) children and 37 of 48 (77%) adults received oseltamivir. Among children, oseltamivir treatment was associated with hospital A (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.36-4.88), clinician-ordered testing performed (aOR, 2.44; 95% CI, 1.47-5.19), intensive care unit (ICU) admission (aOR, 2.09; 95% CI, 1.27-3.45), and age ≥2 years (aOR, 1.43; 95% CI, 1.16-1.76). Among adults, oseltamivir treatment was associated with clinician-ordered testing performed (aOR, 8.38; 95% CI, 4.64-15.12), hospitals D and E (aOR, 3.46-5.11; 95% CI, 1.75-11.01), Hispanic ethnicity (aOR, 2.06; 95% CI, 1.18-3.59), and ICU admission (aOR, 2.05; 95% CI, 1.34-3.13).
Among patients hospitalized with CAP during influenza season, oseltamivir treatment was moderate overall and associated with clinician-ordered testing, severe illness, and specific hospitals. Increased clinician education is needed to include influenza in the differential diagnosis for hospitalized CAP patients and to test and treat patients empirically if influenza is suspected.
关于住院社区获得性肺炎（CAP）患者使用奥司他韦治疗的数据有限。
纳入2010 - 2012年流感季节期间在6家医院因CAP住院的患者。我们使用逻辑回归评估与奥司他韦治疗相关的因素。
1627名儿童（<18岁）中有89名（5%）、1051名成人中有143名（14%）接受了奥司他韦治疗。在临床医生安排的流感检测呈阳性的患者中，61名儿童中有39名（64%）、48名成人中有37名（77%）接受了奥司他韦治疗。在儿童中，奥司他韦治疗与医院A（调整优势比[aOR]，2.76；95%置信区间[CI]，1.36 - 4.88）、进行了临床医生安排的检测（aOR, 2.44；95% CI, 1.47 - 5.19）、入住重症监护病房（ICU）（aOR, 2.09；95% CI, 1.27 - 3.45）以及年龄≥2岁（aOR, 1.43；95% CI, 1.16 - 1.76）相关联。在成人中，奥司他韦治疗与进行了临床医生安排的检测（aOR, 8.38；95% CI, 4.64 - 15.12）、医院D和E（aOR, 3.46 - 5.11；95% CI, 1.75 - 11.01）、西班牙裔种族（aOR, 2.06；95% CI, 1.18 - 3.59）以及入住ICU（aOR, 2.05；95% CI, 1.34 - 3.13）相关联。
在流感季节因CAP住院的患者中，奥司他韦治疗总体适度，且与临床医生安排的检测、重症疾病和特定医院相关。需要加强对临床医生的教育，以便将流感纳入住院CAP患者的鉴别诊断中，并在怀疑流感时对患者进行经验性检测和治疗。
