title: Oseltamivir resistance in adult oncology and hematology patients infected with pandemic (H1N1) 2009 virus, Australia.
abstract: We describe laboratory-confirmed influenza A pandemic (H1N1) 2009 in 17 hospitalized recipients of a hematopoietic stem cell transplant (HSCT) (8 allogeneic) and in 15 patients with malignancy treated at 6 Australian tertiary centers during winter 2009. Ten (31.3%) patients were admitted to intensive care, and 9 of them were HSCT recipients. All recipients of allogeneic HSCT with infection <100 days posttransplantation or severe graft-versus-host disease were admitted to an intensive care unit. In-hospital mortality rate was 21.9% (7/32). The H275Y neuraminidase mutation, which confers oseltamivir resistance developed in 4 of 7 patients with PCR positive for influenza after > or = 4 days of oseltamivir therapy. Three of these 4 patients were critically ill. Oseltamivir resistance in 4 (13.3%) of 30 patients who were administered oseltamivir highlights the need for ongoing surveillance of such resistance and further research on optimal antiviral therapy in the immunocompromised.
authors.affiliation: Peter MacCallum Cancer Centre, East Melbourne, Victoria 3002, Australia. adrian.tramontana@petermac.org
authors.forename: Adrian R
authors.initials: AR
authors.lastname: Tramontana
authors.forename: Biju
authors.initials: B
authors.lastname: George
authors.forename: Aeron C
authors.initials: AC
authors.lastname: Hurt
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Doyle
authors.forename: Katherine
authors.initials: K
authors.lastname: Langan
authors.forename: Alistair B
authors.initials: AB
authors.lastname: Reid
authors.forename: Janet M
authors.initials: JM
authors.lastname: Harper
authors.forename: Karin
authors.initials: K
authors.lastname: Thursky
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Worth
authors.forename: Dominic E
authors.initials: DE
authors.lastname: Dwyer
authors.forename: C Orla
authors.initials: CO
authors.lastname: Morrissey
authors.forename: Paul D R
authors.initials: PD
authors.lastname: Johnson
authors.forename: Kirsty L
authors.initials: KL
authors.lastname: Buising
authors.forename: Simon James
authors.initials: SJ
authors.lastname: Harrison
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Ferguson
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.forename: Justin T
authors.initials: JT
authors.lastname: Denholm
authors.forename: Allen C
authors.initials: AC
authors.lastname: Cheng
authors.forename: Monica
authors.initials: M
authors.lastname: Slavin
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D001315:Australia; D004196:Disease Outbreaks; D024882:Drug Resistance, Viral; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D007362:Intensive Care Units; D053139:Oseltamivir / Q000627:therapeutic use*; D014184:Transplantation, Homologous
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir