Comparing Length of Stay and Clinical Outcomes for Hospitalized Yale

Patients at Bridgeport Hospital who Received Baloxavir Marboxil or NewHaven

Oseltamivir Phosphate During the 2018-2019 Influenza Season Health
Arun Nachiappan, MD ; Wei-Teng Yang, MD MPH 1 1 Bridgeport
1
Department of Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA Hospital
The authors listed contributed equally to this work.

BACKGROUND RESULTS

 BM has been approved for the management of influenza • STUDY POPULATION (N=145): mean age 66.5 years, 43% male.
in otherwise healthy individuals between age 12 and 64.
Fig 1. Summary of patient characteristics.
 The original trial excluded hospitalized patients and those
BM OP p
with co-morbidities.
Length of stay, days, mean (SD) 5.5 (5.3) 8.2 (8.4)  .33
 
METHODS Age, years, mean (SD) 68.3 (18.6) 61.6 (17.8) .05 
Female, n (%) 59 (56.2) 23 (57.5) .89
• Single-center, retrospective analysis of hospitalized Disposition, n (%) .001
patients diagnosed with influenza from 10/01/18 - Floor 99 (94.3) 29 (72.5)  
03/31/19. Progressive care unit 3 (2.9) 6 (15.0)  
Intensive care unit 3 (2.9) 5 (12.5)
1,656 patients diagnosed with influenza between 10/01/18 –
03/31/19 Ethnicity, n (%) .026
*** patients excluded due to incomplete, unavailable or Caucasian 61 (58.1) 15 (37.5)
duplicate charts
Hispanic 25 (23.8) 14 (35.0)
*** patients African American 19 (18.1) 9 (22.5)
*** patients excluded as they were only treated in ED,
Asian 0 (0) 2 (5)
UC or OP setting
Influenza type, n (%) .48 
*** patients A 104 (99.1) 39 (97.5)  
*** patients excluded as they were younger than twelve
B 1 (0.9) 1 (2.5)
years old

*** patients

*** patients excluded as they received neither antiviral,

or were treated before admission
Fig 2. Length of stay (days) was also similar after stratification by reason for hospitalization.
BM OP p
*** patients
Lower respiratory tract infection 6.6 (7.1) 8.2 (9.2) .43
16 patients excluded as they received both antivirals COPD/asthma exacerbation 5.5 (4.8) 4.8 (8.0) .56
Elderly with co-morbidities 5.0 (4.0) 3.4 (6.8) .63
*** patients
Reactive airway disease 4.1 (4.8) 7.4 (1.5) .27
*** patients excluded due to ongoing hospitalization Congestive heart failure exacerbation 9.8 (9.0) 5.6 (5 0) .43

*** patients

*** patients excluded as they were diagnosed before

BM added to formulary
CONCLUSIONS
145 patients’ data used in statistical analysis
• In hospitalized with co-morbidities, there is no difference in length of stay in those who received BM versus OP.

• This highlights the need to clarify the role of BM, given concerns relating to its comparable symptom reduction, greater
• Relationship between length of stay and antiviral used cost and emerging viral resistance (i.e. PA/138T).
ascertained using t-test and multivariate linear regression.
• The future directions include ***.
• Given heterogenous reasons for hospitalization – analysis
stratified by main reasons for hospitalization. • The limitations include retrospective design, small sample size and incomplete data.
• T-test and Wilcoxon’s rank sum test used for continuous
variables, and Pearson’s chi-squared test used for REFERENCES:
categorical variables (α = 0.05). (1) Hayden FG, Sugaya N, Hirotsu N, Lee N, de Jong MD, Hurt AC, Ishida T, Sekino H, Yamada K, Portsmouth S, Kawaguchi K, Shishido T, Arai M, Tsuchiya K, Uehara T,
Watanabe A; Baloxavir Marboxil Investigators Group. Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents. N Engl J Med. 2018 Sep 6;379(10):913-923.
 Yale
NewHaven
An unusual case of fever and rash. Health
Arun Nachiappan, MD ; Wei-Teng Yang, MD MPH
1 1 Bridgeport
1
Department of Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA Hospital
The authors listed contributed equally to this work.

INTRODUCTION
 This case report provides an interesting lesson in the
evaluation of fever and rash in the immunocompetent
host.

 It also highlights the importance of the exposure history.

CASE REPORT
HISTORY

 42 year-old female with a history of asthma who was

admitted with a four-day history of fever and a rash of the
hands and feet.

 One day prior, she was seen in urgent care, and received
prednisone with subsequent worsening of her rash.

 The exposure history was notable for a recent febrile

illness with rash in her son; and her job at a nail salon. Figure 1, 2 & 4. The rash of both and lower extremities, with histopathological analysis of skin biopsy.

 There was no recent travel, medication changes, insect

bites or animal exposure.

PHYSICAL EXAMINATION

 The exam found non-toxic appearance, fever (101.9 °F)

and tachycardia (120).

 There was a confluent, petechial-purpuric rash of the

extremities (Fig. 1 & 2).

 There were no signs indicative of rheumatological disease,

such as oral ulcerations, malar rash or arthritis.

INVESTIGATION

 The laboratory studies were notable for progressive

leukopenia, mildly elevated transaminases and atypical
lymphocytosis – otherwise unremarkable (Fig. 3).
 The skin biopsy was notable for superficial lymphocytic
infiltrate with hemorrhage (Fig. 4).
MANAGEMENT
DISCUSSION
• This case re-iterates the importance of the exposure history in evaluating a fever and rash.
• In the presence of a similar illness in the patient’s six-year old son, histological evidence of lymphocytic infiltrate helped to
rule out vasculitis and – in the context of this unusual rash – prompted consideration of ‘adult-onset papular purpuric gloves
and socks syndrome’ as a differential diagnosis (1).

 The patient was managed with symptomatic therapy, • This syndrome is characterized by a self-limited exanthem typically of viral etiology. Often, viral pathogen is implicated
intravenous fluids and topical steroids – but not (i.e. parvovirus B19), but it was not in this case.
antibiotics.
REFERENCES:
 The patient recovered over several days with resolution of (1) Rosales Santillan M, Dietert JB, Jahan-Tigh R. Adult-onset papular purpuric gloves and socks syndrome. Dermatol Online J. 2018 Apr 15;24(4).
fever, malaise and rash, and was discharged.