title: Antiviral treatment among older adults hospitalized with influenza, 2006-2012.
abstract: OBJECTIVE
  To describe antiviral use among older, hospitalized adults during six influenza seasons (2006-2012) in Davidson County, Tennessee, USA.
  
  
  METHODS
  Among adults ≥50 years old hospitalized with symptoms of respiratory illness or non-localizing fever, we collected information on provider-initiated influenza testing and nasal/throat swabs for influenza by RT-PCR in a research laboratory, and calculated the proportion treated with antivirals.
  
  
  RESULTS
  We enrolled 1753 adults hospitalized with acute respiratory illness. Only 26% (457/1753) of enrolled patients had provider-initiated influenza testing. Thirty-eight patients had a positive clinical laboratory test, representing 2.2% of total patients and 8.3% of tested patients. Among the 38 subjects with clinical laboratory-confirmed influenza, 26.3% received antivirals compared to only 4.5% of those with negative clinical influenza tests and 0.7% of those not tested (p<0.001). There were 125 (7.1%) patients who tested positive for influenza in the research laboratory. Of those with research laboratory-confirmed influenza, 0.9%, 2.7%, and 2.8% received antivirals (p=.046) during pre-pandemic, pandemic, and post-pandemic influenza seasons, respectively. Both research laboratory-confirmed influenza (adjusted odds ratio [AOR] 3.04 95%CI 1.26-7.35) and clinical laboratory-confirmed influenza (AOR 3.05, 95%CI 1.07-8.71) were independently associated with antiviral treatment. Severity of disease, presence of a high-risk condition, and symptom duration were not associated with antiviral use.
  
  
  CONCLUSIONS
  In urban Tennessee, antiviral use was low in patients recognized to have influenza by the provider as well as those unrecognized to have influenza. The use of antivirals remained low despite recommendations to treat all hospitalized patients with confirmed or suspected influenza.
authors: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors: Mary Louise
authors: ML
authors: Lindegren
authors: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Mid-South Geriatric Research Education and Clinical Center, VA TN Valley Health Care System, Nashville, Tennessee, United States of America.
authors: Marie R
authors: MR
authors: Griffin
authors: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors: John V
authors: JV
authors: Williams
authors: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors: Kathryn M
authors: KM
authors: Edwards
authors: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors: Yuwei
authors: Y
authors: Zhu
authors: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors: Ed
authors: E
authors: Mitchel
authors: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors: Alicia M
authors: AM
authors: Fry
authors: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors: William
authors: W
authors: Schaffner
authors: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors: H Keipp
authors: HK
authors: Talbot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007251:Influenza, Human / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058873:Pandemics; D010818:Practice Patterns, Physicians'; D013714:Tennessee / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents