Background Guidelines state that all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals. We sought to determine the frequency of, and factors associated with, antiviral receipt among hospitalized children. Methods We conducted active surveillance of children presenting with fever or respiratory symptoms from 1 December 2016 to 31 March 2020 at 7 pediatric medical centers in the New Vaccine Surveillance Network. The cohort consisted of children hospitalized with influenza A or B confirmed by clinical or research testing. The primary outcome was frequency of antiviral receipt during hospitalization. We used logistic regression to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with antiviral receipt. Results A total of 1213 children with laboratory-confirmed influenza were included. Overall, 652 children (53.8%) received an antiviral. Roughly 63.0% of children received clinical influenza testing. Among those with clinical testing, 67.4% received an antiviral. Factors associated with higher odds of antiviral receipt included hematologic (aOR = 1.76; 95% CI = 1.03–3.02) or oncologic/immunocompromising (aOR = 2.41; 95% CI = 1.13–5.11) disorders, prehospitalization antiviral receipt (aOR = 2.34; 95% CI = 1.49–3.67), clinical influenza testing (aOR = 3.07; 95% CI = 2.28–4.14), and intensive care unit admission (aOR = 1.53; 95% CI = 1.02–2.29). Symptom duration >2 days was associated with lower odds of antiviral treatment (aOR = 0.40; 95% CI = .30–.52). Antiviral receipt varied by site with a 5-fold difference across sites. Conclusions Almost half of children hospitalized with influenza did not receive antivirals. Additional efforts to understand barriers to guideline adherence are crucial for optimizing care in children hospitalized with influenza.

中文翻译：

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实验室确诊流感住院儿童的抗病毒治疗：一项前瞻性、多中心监测研究


背景指南指出，所有疑似或确诊流感的住院儿童都应及时接受流感特异性抗病毒药物治疗。我们试图确定住院儿童接受抗病毒药物的频率和相关因素。方法 我们对 2016 年 12 月 1 日至 2020 年 3 月 31 日在新疫苗监测网络中的 7 个儿科医疗中心出现发热或呼吸道症状的儿童进行了主动监测。该队列由经临床或研究检测确诊的甲型或乙型流感住院儿童组成。主要结局是住院期间接受抗病毒药物的频率。我们使用 logistic 回归来获得与抗病毒接收相关因素的调整比值比 （aORs） 和 95% 置信区间 （CIs）。结果 共纳入 1213 例实验室确诊流感患儿。总体而言，652 名儿童 （53.8%） 接受了抗病毒药物治疗。大约 63.0% 的儿童接受了临床流感检测。在接受临床试验的人中，67.4% 接受了抗病毒药物。与接受抗病毒药物几率较高的因素包括血液学（aOR = 1.76;95% CI = 1.03–3.02）或肿瘤/免疫功能低下（aOR = 2.41;95% CI = 1.13–5.11）疾病、住院前接受抗病毒药物（aOR = 2.34;95% CI = 1.49–3.67）、临床流感检测（aOR = 3.07;95% CI = 2.28–4.14）和重症监护病房收治病房（aOR = 1.53;95% CI = 1.02–2.29）。症状持续时间 >2 天与抗病毒治疗的较低几率相关 （aOR = 0.40;95% CI = .30–.52）。抗病毒药物接收量因研究中心而异，不同研究中心之间相差 5 倍。结论 几乎一半的流感住院儿童没有接受抗病毒药物治疗。 进一步努力了解指南遵守的障碍对于优化流感住院儿童的护理至关重要。