Antiviral Use in Canadian Children Hospitalized for Influenza
Kayur Mehta1, Shaun K Morris2, Julie A Bettinger3
1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Insights
Antiviral use for hospitalized children with influenza remains low in Canada, even for those with chronic conditions. Prescribing practices varied significantly, highlighting the need for improved adherence to treatment guidelines.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Surveillance
- Antimicrobial Stewardship
Background:
- Antiviral medications are recommended for children hospitalized with influenza to reduce severity and duration of illness.
- However, underutilization of these crucial treatments has been observed in pediatric settings.
- Understanding prescribing patterns and associated factors is essential for improving patient outcomes.
Purpose of the Study:
- To describe the utilization of antiviral agents during influenza hospitalizations in Canadian pediatric centers.
- To identify patient and hospital-level factors associated with antiviral prescribing in this population.
Main Methods:
- Active surveillance was conducted for laboratory-confirmed influenza hospitalizations in children aged 16 years or younger across 12 Canadian hospitals from 2010-2011 to 2018-2019.
- Logistic regression analyses were employed to determine factors associated with antiviral use.
Main Results:
- Of 7545 hospitalized children, 41.3% received antiviral agents, with significant variation across sites (10.2%-81.1%) and seasons.
- Antiviral use was higher in children with chronic health conditions (52.7% vs. 36.7%) and associated with older age, recent seasons, local guidelines, rapid lab confirmation, pneumonia, antibiotic use, respiratory support, and ICU admission.
- Antibiotics were administered to 72.8% of patients, indicating potential co-prescinded treatment.
Conclusions:
- Influenza antiviral agents are underused in Canadian pediatric hospitals, including in high-risk children.
- Prescribing patterns demonstrate considerable variation and are influenced by patient and hospital factors.
- Targeted interventions are needed to enhance guideline adherence and antimicrobial stewardship for influenza treatment.
Objectives:
Antivirals are recommended for children hospitalized with influenza but are underutilized. We describe antiviral prescribing during influenza admissions in Canadian pediatric centers and identify factors associated with antiviral use.
Methods:
We performed active surveillance for laboratory-confirmed influenza hospitalizations among children ≤16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from 2010-2011 to 2018-2019. Logistic regression analyses were used to identify factors associated with antiviral use.
Results:
Among 7545 patients, 57.4% were male; median age was 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%) and was more frequent in children with ≥1 chronic health condition (52.7% vs 36.7%; P < .001). On multivariable analysis, factors associated with 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 hospital-level characteristics. Multifaceted hospital-based interventions are warranted to strengthen adherence to influenza treatment guidelines and antimicrobial stewardship practices.
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