TY - JOUR
T1 - Antiviral use in Canadian children hospitalized for influenza
AU - Canadian Immunization Monitoring Program Active (IMPACT) Investigators
AU - Mehta, Kayur
AU - Morris, Shaun K.
AU - Bettinger, Julie A.
AU - Vaudry, Wendy
AU - Jadavji, Taj
AU - Halperin, Scott A.
AU - Bancej, Christina
AU - Sadarangani, Manish
AU - Dendukuri, Nandini
AU - Papenburg, Jesse
N1 - Funding Information:
This surveillance activity is conducted as part of the Canadian Immunization Monitoring Program Active (IMPACT), a national surveillance initiative managed by the Canadian Pediatric Society and conducted by the IMPACT network of pediatric investigators on behalf of the Public Health Agency of Canada's Center for Immunization and Respiratory Infectious Diseases. Public Health Agency of Canada provided input into the study design and was involved in the review and approval of the manuscript.
Funding Information:
FINANCIAL DISCLOSURE: Dr Papenburg reports grants from MedImmune, grants from Sanofi Pasteur, grants and personal fees from Seegene, and grants and personal fees from AbbVie, outside the submitted work. Dr Sadarangari has been an investigator on projects funded by GlaxoSmithKline, Merck, Pfizer, Sanofi-Pasteur, Seqirus, Symvivo, and VBI Vaccines. All funds have been paid to his institute, and he has not received any personal payments. Dr Halperin has been an investigator on projects funded by Sanofi-Pasteur, GlaxoSmithKline, and Seqirus. FUNDING: This surveillance activity is conducted as part of the Canadian Immunization Monitoring Program Active (IMPACT), a national surveillance initiative managed by the Canadian Pediatric Society and conducted by the IMPACT network of pediatric investigators on behalf of the Public Health Agency of Canada’s Center for Immunization and Respiratory Infectious Diseases. Public Health Agency of Canada provided input into the study design and was involved in the review and approval of the manuscript. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
Publisher Copyright:
Copyright © 2021 by the American Academy of Pediatrics.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - OBJECTIVES: Antivirals are recommendedfor childrenhospitalizedwithinfluenzabut areunderutilized. abstract We describe antiviral prescribing during influenza admissions in Canadian pediatric centers and identify factors associatedwith antiviral use. METHODS: We performedactive surveillance for laboratory-confirmed influenza hospitalizations among children ≤ 16 years old at the 12 Canadian Immunization Monitoring Program Activehospitals, from 2010-2011to 2018-2019.Logistic regression analyses were used to identify factor sassociated with antiviraluse. RESULTS: Among 7545 patients, 57.4% weremale;median agewas 3 years (interquartile range: 1.1-6.3). Overall, 41.3% received antiviral agents; 72.8% received antibiotics. Antiviral use varied across sites (range, 10.2% to 81.1%) and influenza season (range, 19.9% to 59.6%) andwasmore frequent in children with ≥1 chronic health condition (52.7% vs 36.7%; P< .001). On multivariable analysis, factors associatedwith antiviral use included older age (adjusted odds ratio [aOR] 1.04 [95% confidence interval (CI), 1.02-1.05]),more recent season (highest aOR 9.18 [95% CI, 6.70-12.57] for 2018-2019), admission during peak influenza period (aOR 1.37 [95% CI, 1.19-1.58]), availability of local treatment guideline (aOR 1.54 [95% CI, 1.17-2.02]), timing of laboratory confirmation (highest aOR 2.67 [95% CI, 1.97-3.61] for result available before admission), presence of chronic health conditions (highest aOR 4.81 [95% CI, 3.61-6.40] for cancer), radiographically confirmed pneumonia (aOR 1.39 [95% CI, 1.20-1.60]), antibiotic treatment (aOR 1.51 [95% CI, 1.30-1.76]), respiratory support (1.57 [95% CI, 1.19-2.08]), and ICU admission (aOR 3.62 [95% CI, 2.88-4.56]). CONCLUSIONS: Influenza antiviral agents were underused in Canadian pediatric hospitals, including among children with high-risk chronic health conditions. Prescribing varied considerably across sites, increased over time, and was associated with patient and hospitallevel characteristics. Multifaceted hospital-based interventions are warranted to strengthen adherence to influenza treatment guidelines and antimicrobial stewardship practices.
AB - OBJECTIVES: Antivirals are recommendedfor childrenhospitalizedwithinfluenzabut areunderutilized. abstract We describe antiviral prescribing during influenza admissions in Canadian pediatric centers and identify factors associatedwith antiviral use. METHODS: We performedactive surveillance for laboratory-confirmed influenza hospitalizations among children ≤ 16 years old at the 12 Canadian Immunization Monitoring Program Activehospitals, from 2010-2011to 2018-2019.Logistic regression analyses were used to identify factor sassociated with antiviraluse. RESULTS: Among 7545 patients, 57.4% weremale;median agewas 3 years (interquartile range: 1.1-6.3). Overall, 41.3% received antiviral agents; 72.8% received antibiotics. Antiviral use varied across sites (range, 10.2% to 81.1%) and influenza season (range, 19.9% to 59.6%) andwasmore frequent in children with ≥1 chronic health condition (52.7% vs 36.7%; P< .001). On multivariable analysis, factors associatedwith antiviral use included older age (adjusted odds ratio [aOR] 1.04 [95% confidence interval (CI), 1.02-1.05]),more recent season (highest aOR 9.18 [95% CI, 6.70-12.57] for 2018-2019), admission during peak influenza period (aOR 1.37 [95% CI, 1.19-1.58]), availability of local treatment guideline (aOR 1.54 [95% CI, 1.17-2.02]), timing of laboratory confirmation (highest aOR 2.67 [95% CI, 1.97-3.61] for result available before admission), presence of chronic health conditions (highest aOR 4.81 [95% CI, 3.61-6.40] for cancer), radiographically confirmed pneumonia (aOR 1.39 [95% CI, 1.20-1.60]), antibiotic treatment (aOR 1.51 [95% CI, 1.30-1.76]), respiratory support (1.57 [95% CI, 1.19-2.08]), and ICU admission (aOR 3.62 [95% CI, 2.88-4.56]). CONCLUSIONS: Influenza antiviral agents were underused in Canadian pediatric hospitals, including among children with high-risk chronic health conditions. Prescribing varied considerably across sites, increased over time, and was associated with patient and hospitallevel characteristics. Multifaceted hospital-based interventions are warranted to strengthen adherence to influenza treatment guidelines and antimicrobial stewardship practices.
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U2 - 10.1542/peds.2020-049672
DO - 10.1542/peds.2020-049672
M3 - Article
C2 - 34548379
AN - SCOPUS:85116514514
SN - 0031-4005
VL - 148
JO - Pediatrics
JF - Pediatrics
IS - 4
M1 - e2020049672
ER -