Influenza testing low for many patients with community-acquired pneumonia
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In a new study, most patients with community-acquired pneumonia did not receive testing for influenza, even during influenza season, researchers reported in Chest.
“Other than CDC surveillance data, no studies have evaluated the frequency of influenza testing among patients hospitalized with pneumonia across a representative sample of U.S. hospitals,” Abhishek Deshpande, MD, PhD, assistant professor of medicine in the department of infectious diseases at the Center for Value-Based Care Research at Cleveland Clinic, and colleagues wrote. “Similarly, there are limited data regarding the impact of influenza testing or treatment on outcomes of patients with community-acquired pneumonia.”
The multicenter, retrospective cohort study included 166,268 adults with community-acquired pneumonia (mean age, 69.4 years; 49.6% men) admitted from 2010 to 2015 to 179 hospitals contributing to the Premier database in the U.S. Researchers evaluated rates of influenza testing and compared the use of antimicrobials and outcomes of test-positive, test-negative and untested patients. In addition, researchers also assessed associations of early antiviral treatment with oseltamivir with 14-day in-hospital mortality, hospital length of stay and cost.
Only 23.3% of patients with community-acquired pneumonia were tested for influenza. Of those, 11.5% tested positive.
From 2010 to 2015, influenza testing increased from 15.4% to 35.6%, and the rate was 28.9% during influenza season compared with 8.2% from June to September.
Patients who tested positive for influenza also received antiviral agents more often (87.8% vs. 76.6%; P < .001) and antibacterial agents less often (82.1% vs. 99.7%; P < .001) and for shorter courses (5.3 vs. 6.4 days; P < .001) compared with those who tested negative.
The 2,585 patients who tested positive for influenza and received oseltamivir on the first day of hospital admission had lower rate of 14-day in-hospital mortality (adjusted OR = 0.75; 95% CI, 0.59-0.96), lower costs (adjusted ratio of means = 0.88; 95% CI, 0.81-0.95) and shorter hospital length of stay (adjusted ratio of means = 0.88; 95% CI, 0.84-0.93) compared with the 1,742 patients who received oseltamivir later or never.
“Our analyses suggest an opportunity to improve influenza testing and antimicrobial prescribing among inpatients with suspected pneumonia,” the researchers wrote. “Early treatment with oseltamivir may result in better clinical outcomes.”
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