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Original Research: Chest Infections |

Outcomes and Prognostic Features of Patients With Influenza Requiring Hospitalization and Receiving Early Antiviral Therapy: A Prospective Multicenter Cohort Study

Takaya Maruyama, MD, PhD; Takao Fujisawa, MD, PhD; Shigeru Suga, MD, PhD; Haruna Nakamura, MD; Mizuho Nagao, MD, PhD; Kiyosu Taniguchi, MD, PhD; Kiyoyuki Tsutsui, MD, PhD; Toshiaki Ihara, MD, PhD; Michael S. Niederman, MD
Author and Funding Information

FUNDING/SUPPORT: This study was funded by a National Hospital Organization collaborative clinical research grant [H22-NHO infection-01].

CORRESPONDENCE TO: Michael S. Niederman, MD, New York Presbyterian Hospital, Weill Cornell Medical Center, 425 E 61st St, New York, NY 10065


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(2):526-534. doi:10.1378/chest.14-2768
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Background  In Japan, the routine use of early antiviral therapy for patients with influenza is standard.

Methods  This multicenter prospective cohort evaluation of hospitalized patients with laboratory-confirmed influenza identified prognostic factors among the patients receiving antiviral therapy.

Results  Of 1,345 patients with influenza (766 pediatric, 579 adult), excluding those aged < 1 year (who are not approved for antiviral therapy), 97.7% (1,224 of 1,253) received antiviral therapy. Among the adult patients, 24 (4.1%) died within 30 days, whereas none of the pediatric patients died. Five hundred twenty-eight (91.2%) adult patients had influenza A, 509 (87.9%) had a chronic underlying illness, and 211 (36.4%) had radiographically confirmed pneumonia. Twenty of the 24 patients who died had pneumonia of the following etiologies: Streptococcus pneumoniae (12.3%); Staphylococcus aureus (10.9%), including methicillin-resistant S aureus (MRSA) 3.3%; Enterobacteriaceae (8.1%); and Pseudomonas aeruginosa (3.3%). Of the adult patients, 151 were classified as having community-acquired pneumonia (CAP) and 60 as having health-care-associated pneumonia (HCAP). Inappropriate therapy was more common in HCAP than in CAP (15.2% vs 2%, P = .001). Potential multidrug-resistant (MDR) pathogens were more common (21.7% vs 2.6%, P < .001) in patients with HCAP, particularly MRSA (10% vs 0.7%, P = .002) and P aeruginosa (8.3% vs 1.3%, P = .021). Using Cox proportional hazards modeling with prescribed independent variables, male sex, severity score, serum albumin levels (malnutrition), and pneumonia were associated with survival 30 days from the onset of influenza.

Conclusions  Among the prognostic factors, malnutrition and pneumonia are amenable to medical intervention. An opportunity exists to improve empirical therapy for patients with HCAP and influenza.

Trial Registry  Japan Medical Association Center for Clinical Trials; No.: JMA-IIA00123; URL: http://www.jmacct.med.or.jp/en/

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