Oseltamivir-resistant 2009 H1N1 influenza pneumonia during therapy in a renal transplant recipient

Pediatr Transplant. 2012 Aug;16(5):E153-7. doi: 10.1111/j.1399-3046.2011.01489.x. Epub 2011 Mar 9.


The emergence of oseltamivir-resistant 2009 H1N1 influenza virus (conferred by the H275Y substitution in NA) during therapy or prophylaxis in immunocompromised patients is a serious concern. The optimal therapy for immunosuppressed patients with oseltamivir-resistant 2009 H1N1 influenza virus is unknown and few options exist. We report a 10-yr-old recipient of kidney transplant who was hospitalized with oseltamivir-resistant 2009 H1N1 influenza pneumonia complicated by severe respiratory failure, ARDS, and renal failure requiring institution of ECMO and CRRT. On presentation, treatment with oseltamivir (second course) and broad-spectrum antibiotics was initiated. Immunosuppressive agents were stopped on hospital day (d) 2. On hospital d 7, given his critical status, immunocompromised state, and difficulty in obtaining intravenous zanamivir, after obtaining ethical approval and parental consent, he was treated with intravenous peramivir (through an Emergency Investigational New Drug Application) for two wk. He tolerated the regimen well and his clinical status improved gradually. Several factors may have contributed to virus clearance and survival including recovery of the immune system, aggressive critical care support, and administration of peramivir. Ongoing surveillance is essential to monitor how oseltamivir-resistant H275Y mutant viruses may evolve in the future.

Publication types

  • Case Reports

MeSH terms

  • Antiviral Agents / pharmacology
  • Antiviral Agents / therapeutic use*
  • Child
  • Drug Resistance, Viral*
  • Humans
  • Immunocompromised Host
  • Influenza A Virus, H1N1 Subtype / drug effects*
  • Influenza A Virus, H1N1 Subtype / isolation & purification
  • Influenza, Human / diagnosis
  • Influenza, Human / drug therapy
  • Influenza, Human / immunology*
  • Influenza, Human / virology
  • Kidney Transplantation
  • Male
  • Oseltamivir / pharmacology
  • Oseltamivir / therapeutic use*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / virology
  • Postoperative Complications / diagnosis
  • Postoperative Complications / drug therapy
  • Postoperative Complications / immunology*
  • Postoperative Complications / virology


  • Antiviral Agents
  • Oseltamivir