Duration of viral shedding and factors associated with prolonged shedding among inpatients with influenza treated with oseltamivir: a prospective cohort study
Duration of viral shedding and factors associated with prolonged shedding among inpatients with influenza treated with oseltamivir: a prospective cohort study
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DOI：
10.1007/s10096-017-3135-0
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发表时间：
2018-02-01
影响因子：
4.5
通讯作者：
Neuberger, A.
中科院分区：
文献类型：
--
作者：
Khoury, J.;Szwarcwort, M.;Neuberger, A.
本研究的目的是确定奥司他韦给药后流感PCR检测诊断率的下降率，并确定长时间脱落的危险因素。这是一项前瞻性观察性研究。我们纳入了2015年和2016年流感季节有流感临床症状的成年住院患者，这些患者的流感PCR检测呈阳性，并接受了奥司他韦治疗。于首次阳性检测后第2、4、6天进行临床随访和重复PCR检测。我们将延长的脱落定义为仍然需要住院治疗并且在第4天PCR检测阳性的患者。通过单因素和多因素分析评估长时间脱毛的危险因素。我们的研究共纳入215例患者。中位年龄为64岁，49.3%为男性。流感类型以H1N1为主（50.1%）。第2、4、6天可评估患者PCR阳性率分别为142/215（66%）、50/78（64.1%）和20/30（66.6%）。长期脱落（50例）的独立危险因素包括入院时低氧血症[比值比（OR） 2.55, 95%可信区间（1.3-5.1）]和较低的舒张压[OR 0.94, 95% CI(0.92-0.97)]。治疗开始后超过48小时进行PCR阴性检测，诊断率较低。更严重的疾病，表现为低氧血症和低血压，与奥司他韦治疗的长期脱落有关。
The purpose of this study was to determine the rate of decline in the diagnostic yield of influenza PCR assay after oseltamivir administration, and to identify risk factors for prolonged shedding. This was a prospective observational study. We included adult inpatients with clinical signs of influenza during the influenza seasons 2015 and 2016, who had positive influenza PCR tests and who were treated with oseltamivir. Clinical follow-up and repeat PCR testing were performed on days 2, 4 and 6 after the first positive test. We defined prolonged shedders as patients who still required hospitalization and had a positive PCR assay on day 4. Risk factors for prolonged shedding were assessed in univariate and multivariate analyses. A total of 215 patients were included in our study. The median age was 64 years and 49.3% were men. The main influenza type was H1N1 (50.1%). Rates of PCR positivity among evaluable patients on days 2, 4 and 6 were 142/215 (66%), 50/78 (64.1%) and 20/30 (66.6%), respectively. Independent risk factors for prolonged shedding (50 patients) included hypoxemia [odds ratio (OR) 2.55, 95% confidence interval (1.3-5.1)] and lower diastolic blood pressure [OR 0.94, 95% CI (0.92-0.97)] on admission. Negative PCR tests taken more than 48 h after initiation of treatment had low diagnostic yield. More severe disease, manifested by hypoxemia and lower blood pressure, is associated with prolonged shedding on oseltamivir treatment.