Antoon James W, Amarin Justin Z, Hamdan Olla, Stopczynski Tess, Stewart Laura S, Michaels Marian G, Williams John V, Klein Eileen J, Englund Janet A, Weinberg Geoffrey A, Szilagyi Peter G, Schuster Jennifer E, Selvarangan Rangaraj, Harrison Christopher J, Boom Julie A, Sahni Leila C, Muñoz Flor M, Staat Mary Allen, Schlaudecker Elizabeth P, Chappell James D, Clopper Benjamin R, Moline Heidi L, Campbell Angela P, Spieker Andrew J, Olson Samantha M, Halasa Natasha B
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Epidemiology Doctoral Program, Vanderbilt University, Nashville, Tennessee, USA.
Clin Infect Dis. 2024 Dec 17. doi: 10.1093/cid/ciae573.
Guidelines state that all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals. We sought to determine the frequency of, and factors associated with, antiviral receipt among hospitalized children.
We conducted active surveillance of children presenting with fever or respiratory symptoms from 1 December 2016 to 31 March 2020 at 7 pediatric medical centers in the New Vaccine Surveillance Network. The cohort consisted of children hospitalized with influenza A or B confirmed by clinical or research testing. The primary outcome was frequency of antiviral receipt during hospitalization. We used logistic regression to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with antiviral receipt.
A total of 1213 children with laboratory-confirmed influenza were included. Overall, 652 children (53.8%) received an antiviral. Roughly 63.0% of children received clinical influenza testing. Among those with clinical testing, 67.4% received an antiviral. Factors associated with higher odds of antiviral receipt included hematologic (aOR = 1.76; 95% CI = 1.03-3.02) or oncologic/immunocompromising (aOR = 2.41; 95% CI = 1.13-5.11) disorders, prehospitalization antiviral receipt (aOR = 2.34; 95% CI = 1.49-3.67), clinical influenza testing (aOR = 3.07; 95% CI = 2.28-4.14), and intensive care unit admission (aOR = 1.53; 95% CI = 1.02-2.29). Symptom duration >2 days was associated with lower odds of antiviral treatment (aOR = 0.40; 95% CI = .30-.52). Antiviral receipt varied by site with a 5-fold difference across sites.
Almost half of children hospitalized with influenza did not receive antivirals. Additional efforts to understand barriers to guideline adherence are crucial for optimizing care in children hospitalized with influenza.
指南规定，所有疑似或确诊流感的住院儿童均应及时接受流感特异性抗病毒药物治疗。我们试图确定住院儿童接受抗病毒治疗的频率及其相关因素。
2016年12月1日至2020年3月31日期间，我们在新疫苗监测网络的7家儿科医疗中心对出现发热或呼吸道症状的儿童进行了主动监测。该队列包括经临床或研究检测确诊为甲型或乙型流感的住院儿童。主要结局是住院期间接受抗病毒治疗的频率。我们使用逻辑回归分析来获得与抗病毒治疗相关因素的调整比值比（aOR）和95%置信区间（CI）。
共纳入1213例实验室确诊流感的儿童。总体而言，652例儿童（53.8%）接受了抗病毒治疗。约63.0%的儿童接受了临床流感检测。在接受临床检测的儿童中，67.4%接受了抗病毒治疗。与接受抗病毒治疗几率较高相关的因素包括血液系统疾病（aOR = 1.76；95%CI = 1.03 - 3.02）或肿瘤/免疫功能低下疾病（aOR = 2.41；95%CI = 1.13 - 5.11）、住院前接受抗病毒治疗（aOR = 2.34；95%CI = 1.49 - 3.67）、临床流感检测（aOR = 3.07；95%CI = 2.28 - 4.14）以及入住重症监护病房（aOR = 1.53；95%CI = 1.02 - 2.29）。症状持续时间>2天与接受抗病毒治疗的几率较低相关（aOR = 0.40；95%CI = 0.30 - 0.52）。抗病毒治疗的接受情况因地点而异，各地点之间存在5倍的差异。
近一半的流感住院儿童未接受抗病毒治疗。进一步努力了解指南依从性的障碍对于优化流感住院儿童的治疗至关重要。
