Oseltamivir resistance in adult oncology and hematology patients infected with pandemic (H1N1) 2009 virus, Australia.
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.
Tramontana
Adrian R
AR
Peter MacCallum Cancer Centre, East Melbourne, Victoria 3002, Australia. adrian.tramontana@petermac.org
George
Biju
B
Hurt
Aeron C
AC
Doyle
Joseph S
JS
Langan
Katherine
K
Reid
Alistair B
AB
Harper
Janet M
JM
Thursky
Karin
K
Worth
Leon J
LJ
Dwyer
Dominic E
DE
Morrissey
C Orla
CO
Johnson
Paul D R
PD
Buising
Kirsty L
KL
Harrison
Simon James
SJ
Seymour
John F
JF
Ferguson
Patricia E
PE
Wang
Bin
B
Denholm
Justin T
JT
Cheng
Allen C
AC
Slavin
Monica
M
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
D000998:Antiviral Agents; D053139:Oseltamivir