Influenza Diagnostic Tests Improve Suitability of Antiviral Treatment in Hospitalized Children


Yeara

2015

2016

Number of hospital admissions

336

331

Number of person-days

498

518

Reasons for admission (%):
  
 pneumonia

15

14

 bronchitis/bronchiolitis

27

24

 upper respiratory tract infection

11

12

 gastroenterocolitis

22

32

 urinary tract infection

9

9

 others

16

9


aFrom January 1 to March 31



We compared treatment of the laboratory confirmed influenza in children aged 0–60 months. The children were hospitalized due to the presence of influenza-like illness according to the CDC criteria, such as fever > 37.8 °C, cough, or sore throat, during the two consecutive years of 2015 and 2016, from January 1 to March 31 each. In the first year, when RIDT was unavailable, 52 patients fulfilled the inclusion criteria and the retrospective diagnosis of influenza was based on the result of the real time qRT-PCR. In the second year, 63 patients were enrolled into study and all of them were tested with both real time qRT-PCR and RIDT (bioNexia Influenza A+B, bioMerieux; Marcy-l’Étoile, France) according to manufacturer’s recommendations. Each year, nasopharyngeal swabs were taken from children by a trained nurse, transported to the laboratory at the National Influenza Center in Warsaw, Poland, collected and tested. The results were obtained in a retrospective manner, after the patient had been discharged from the hospital. The detailed methodology of the real time qRT-PCR was described previously (Nitsch-Osuch et al. 2013b). The demographic characteristics of children included into the study are shown in the Table 2. There were no significant differences between the patients of the two years. We compared the proportion of patients who received a causative treatment of influenza with oseltamivir and/or antibiotic treatment in the second year when RIDT was available with the antibiotic treatment in the first year under consideration when RIDT was not yet available. The statistical analysis for nominal variables was performed with the chi-squared test; when a sample of patients was too small, Fisher’s exact test was used. The level of significance was defined as α = 0.05. The calculations were conducted with a medical statistical calculator available at the website www.​medcal3000.​com.


Table 2
Demographic characteristics of patients




































Yeara

2015

2016

Number of patients (n)

52

63

Gender (n, % of patients)

  boys

29 (56)

43 (69)

  girls

23 (44)

20 (31)

Age (n, % of patients)

  ≤ 24 months

35 (67 %)

46 (73 %)

  25–60 months

17 (33 %)

17 (27 %)


aFrom January 1 to March 31



3 Results


In the 2015 epidemic season when all cases of influenza were recognized retrospectively by real time qRT-PCR, the number of patients with confirmed influenza was 15/52; which amounts to the attack rate of 28 %. There were 2 cases of influenza type B virus, lineage Yamagata, and 13 cases of influenza type A(H3N2) virus. In the following season when influenza was diagnosed with both RIDT and real time qRT-PCR, the number of patients with confirmed influenza was 11/63, which amounts to the attack rate of 17 %. There were two cases of influenza type B, lineage Victoria, and nine cases of influenza type A H1N1 pdm09 virus. The diagnosis of influenza was based on a positive result of RIDT and a positive result of the real time qRT-PCR in 7/11 (64 %) patients, while a false negative results of the RIDT with a positive real time qRT-PCR test were obtained in 4/11 (36 %) patients. The demographic characteristics of children with influenza are presented in Table 3.


Table 3
Demographics of patients with influenza








































Yeara

2015

2016

Number of patients (n)

(n = 15)

(n = 11)

Gender (n, % of patients):
   

  boys

7 (47)

5 (45)

  girls

8 (53)

6 (55)

Age (n, % of patients):
   

  ≤ 24 months

10 (67)

3 (27)

  25–60 months

5 (33)

8 (73)


aFrom January 1 to March 31

In the 2015 season, when RIDT was not available, none of the children with influenza was treated with oseltamivir, while in the 2016 season, when RIDT became available, 7/11 (64 %) patients with influenza received the antiviral treatment (Table 4). This difference in the administration of treatment with oseltamivir in two consecutive years was significant (p < 0.05). Antibiotic therapy in children with influenza was statistically more frequently administrated when RIDT was not yet available compared with the time when it was (93 % vs. 64 %, respectively; p < 0.05). Although laboratory confirmation of influenza was established, 3/7 (43 %) patients received both oseltamivir and antibiotics. Cefuroxime was co-administered in two cases and amoxicillin with clavulanate in one case due to the presence of clinical symptoms of pneumonia, confirmed by X-ray chest examination. The remaining four patients with confirmed influenza received antibiotics alone (Table 4).


Table 4
Treatment of children with laboratory confirmed influenza in two consecutive years – oseltamivir vs. antibiotic therapy





































Yeara

2015

2016

p-value

RIDT

Unavailable

Available
 

Number of children with influenza treated with oseltamivir

0

7/11

p < 0.05

Proportion of children with influenza who received oseltamivir

0 %

64 %

Number of children with influenza treated with antibiotics

14b/15

7c/11

p < 0.05

Proportion of children with influenza treated with antibiotics

93 %

64 %

Jul 14, 2017 | Posted by in RESPIRATORY | Comments Off on Influenza Diagnostic Tests Improve Suitability of Antiviral Treatment in Hospitalized Children

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