title: Degree of adherence to recommended antiviral treatment during the pandemic and post-pandemic periods of influenza A(H1N1)pdm09 in 148 intensive care units in Spain.
abstract: OBJECTIVE
  To determine the degree of antiviral treatment recommendations adherence and its impact to critical ill patients affected by influenza A(H1N1)pdm09 mortality.
  
  
  METHODS
  Secondary analysis of prospective study.
  
  
  METHODS
  Intensive care (UCI).
  
  
  METHODS
  Patients with influenza A(H1N1)pdm09 in the 2009 pandemic and 2010-11 post-Pandemic periods.
  
  
  METHODS
  Adherence to recommendations was classified as: Total (AT); partial in doses (PD); partial in time (PT), and non-adherence (NA). Viral pneumonia, obesity and mechanical ventilation were considered severity criteria for the administration of high antiviral dose. The analysis was performed using t-test or «chi» square. Survival analysis was performed and adjusted by Cox regression analysis.
  
  
  RESULTS
  A total of 1,058 patients, 661 (62.5%) included in the pandemic and 397 (37.5%) in post-pandemic period respectively. Global adherence was achieved in 41.6% (43.9% and 38.0%; P=.07 respectively). Severity criteria were similar in both periods (68.5% vs. 62.8%; P=.06). The AT was 54.7% in pandemic and 36.4% in post-pandemic period respectively (P<.01). The NA (19.7% vs. 11.3%; P<.05) and PT (20.8% vs. 9.9%, P<.01) was more frequent in the post-pandemic period. The mortality rate was higher in the post-pandemic period (30% vs. 21.8%, P<.001). APACHE II (HR=1.09) and hematologic disease (HR=2.2) were associated with a higher mortality and adherence (HR=0.47) was a protective factor.
  
  
  CONCLUSIONS
  A low degree of adherence to the antiviral treatment was observed in both periods. Adherence to antiviral treatment recommendations was associated with lower mortality rates and should be recommended in critically ill patients with suspected influenza A(H1N1)pdm09.
authors.affiliation: Servicio de Farmacia Hospitalaria, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut d'Investigaciò Sanitaria Pere Virgili, Tarragona, España.
authors.forename: L
authors.initials: L
authors.lastname: Canadell
authors.affiliation: Servicio de Medicina Intensiva, Corporación Sanitaria Parc Taulí, CIBERES, Sabadell, España.
authors.forename: I
authors.initials: I
authors.lastname: Martín-Loeches
authors.affiliation: Servicio de Medicina Intensiva, Corporación Sanitaria Parc Taulí, CIBERES, Sabadell, España.
authors.forename: E
authors.initials: E
authors.lastname: Díaz
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut d'Investigaciò Sanitaria Pere Virgili, Tarragona, España.
authors.forename: S
authors.initials: S
authors.lastname: Trefler
authors.affiliation: Servicio de Farmacia Hospitalaria, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: S
authors.initials: S
authors.lastname: Grau
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Mataró, Mataró, España.
authors.forename: J C
authors.initials: JC
authors.lastname: Yebenes
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Mataró, Mataró, España.
authors.forename: J
authors.initials: J
authors.lastname: Almirall
authors.affiliation: Servicio de Medicina Preventiva - Hospital Universitario de Tarragona Joan XXIII, Tarragona, España.
authors.forename: M
authors.initials: M
authors.lastname: Olona
authors.affiliation: Cátedra de Farmacología clínica - Universidad Rovira i Virgili, Tarragona, España.
authors.forename: F
authors.initials: F
authors.lastname: Sureda
authors.affiliation: Servicio de Medicina Intensiva, Hospital Clínico, Valencia, España.
authors.forename: J
authors.initials: J
authors.lastname: Blanquer
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut d'Investigaciò Sanitaria Pere Virgili, Tarragona, España; Centros de Investigación Biomédica en Red Enfermedades Respiratorias , Tarragona, España. Electronic address: ahr1161@yahoo.es.
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000188:drug therapy* / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D053139:Oseltamivir / Q000627:therapeutic use; D058873:Pandemics; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D016903:Drug Monitoring
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir
keywords: Adherence; Adherencia; Antiviral treatment; Gripe A (H1N1)pdm09; Influenza A(H1N1)pdm09; Prognosis; Pronóstico; Tratamiento antivírico