Neuraminidase inhibitors and hospital length of stay: a meta-analysis of individual participant data to determine treatment effectiveness among patients hospitalized with nonfatal 2009 pandemic influenza A(H1N1) virus infection

Research output: Contribution to journalArticlepeer-review


  • PRIDE Consortium Investigators
  • Sudhir Venkatesan
  • Puja R Myles
  • Kirsty J Bolton
  • Stella G Muthuri
  • Tarig Al Khuwaitir
  • Ashish P Anovadiya
  • Eduardo Azziz-Baumgartner
  • Tahar Bajjou
  • Matteo Bassetti
  • Bojana Beovic
  • Barbara Bertisch
  • Isabelle Bonmarin
  • Robert Booy
  • Victor H Borja-Aburto
  • Heinz Burgmann
  • Bin Cao
  • Jordi Carratala
  • Tserendorj Chinbayar
  • Catia Cilloniz
  • Justin T Denholm
  • Samuel R Dominguez
  • Pericles A D Duarte
  • Gal Dubnov-Raz
  • Sergio Fanella
  • Zhancheng Gao
  • Patrick Gérardin
  • Maddalena Giannella
  • Sophie Gubbels
  • Jethro Herberg
  • Anjarath Lorena Higuera Iglesias
  • Peter H Hoeger
  • Xiao Yun Hu
  • Quazi T Islam
  • Mirela F Jiménez
  • Gerben Keijzers
  • Hossein Khalili
  • Gabriela Kusznierz
  • Ilija Kuzman
  • Eduard Langenegger
  • Kamran B Lankarani
  • Yee-Sin Leo
  • Romina P Libster
  • Rita Linko
  • Faris Madanat
  • Efstratios Maltezos
  • Abdullah Mamun
  • Toshie Manabe
  • Gokhan Metan
  • Auksė Mickiene
  • Dhruv Parekh

Colleges, School and Institutes

External organisations

  • University of Nottingham
  • University College London Hospitals NHS Foundation Trust
  • Department of Medicine, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
  • Department of Pharmacology, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, India.
  • Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • University Mohammed V-Souissi, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Biosafety Level 3 and Research Laboratory, Rabat, Morocco.
  • Clinic of Rheumatology, University Hospital Santa Maria della Misericordia, Udine, Italy.
  • Department of Infectious Diseases, University Medical Center, Ljubljana.
  • University of Geneva
  • Institut de Veille Sanitaire, Saint Maurice, France.
  • National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, University of Sydney.
  • División de Laboratorios de Vigilancia e Investigación Epidemiológica, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
  • Medical University of Vienna
  • Capital Medical University
  • Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases.
  • National Influenza Center, National Center of Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia.
  • Universitat de Barcelona
  • Victorian Infectious Diseases Service and Department of Microbiology and Immunology, at the Peter Doherty Institute for Infection and Immunity, Parkville.
  • University of Colorado
  • Universidade Estadual do Oeste do Paraná-UNIOESTE, Cascavel.
  • Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan.
  • University of Manitoba
  • Peking University
  • Unité Mixte 134 Processus Infectieux en Milieu Insulaire Tropical, Centre National de la Recherche Scientifique 9192, INSERM U1187, Institut Recherche et Développement 249, Université de la Réunion, Cyclotron Réunion-océan Indien, Sainte Clotilde, Reunion.
  • Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid.
  • Department of Infectious Disease Epidemiology, Sector for National Health Documentation and Research, Statens Serum Institut, Copenhagen, Denmark.
  • Imperial College London
  • Department of Research in Clinical Epidemiology, Instituto Nacional de Enfermedades Respiratorias Dr. Ismael Cosío Villegas, Mexico City, Mexico.
  • Catholic Children's Hospital Wilhelmstift, Hamburg.
  • Peking Union Medical College Hospital
  • Dhaka Medical College Hospital, Bangladesh.
  • Departamento de Ginecologia e Obstetrícia-UFCSPA, Preceptora da Residência Médica do Hospital Fêmina, Fêmina, Brazil.
  • Gold Coast University Hospital, Gold Coast, Australia.
  • Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
  • National Institute of Respiratory Diseases "Emilio Coni" ANLIS "C. Malbran," Santa Fe.
  • University of Zagreb
  • Stellenbosch University-Tygerberg
  • Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
  • Department of Infectious Diseases, Tan Tock Seng Hospital.
  • National Scientific and Technical Research Council, Buenos Aires.
  • University of Helsinki
  • Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan.
  • Unit of Infectious Diseases, University General Hospital of Alexandroupolis, Democritus University Thrace, Dragana.
  • Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
  • Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
  • Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara.
  • Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
  • University of Birmingham


BACKGROUND: The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear.

METHODS: We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded.

RESULTS: We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78-.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS.

CONCLUSIONS: When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.

Bibliographic note

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail:


Original languageEnglish
Pages (from-to)356-366
Number of pages11
JournalThe Journal of Infectious Diseases
Issue number3
Early online date17 Jul 2019
Publication statusPublished - 1 Feb 2020


  • IPD meta-analysis, Neuraminidase inhibitors, antivirals, length of stay, pandemic influenza

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