Common emergence of amantadine- and rimantadine-resistant influenza A viruses in symptomatic immunocompromised adults

The importance and significance of amantadine-or rimantadine-resistant influenza viruses in immunocompromised patients was studied in a population of adult bone marrow transplant (BR IT) recipients and patients with leukemia prospectively cultured for respiratory viruses. Influenza A viruses were isolated from 29 patients with acute respiratory illness (14 BMT recipients and 15 patients with leukemia). Fifteen patients (52%) received amantadine(n = 4) or rimantadine (n = 11) therapy. All influenza isolates recovered from six patients shedding virus for greater than or equal to 3 days were screened for antiviral susceptibility; resistant isolates were further genetically characterized. Initial influenza isolates were susceptible to amantadine or rimantadine, but subsequent isolates from five of six patients were resistant. Influenza-associated mortality was similar among patients with and without documented antiviral resistance (2 of 5 vs. 5 of 24). We conclude that development of antiviral resistance in immunocompromised individuals should be considered when they have been treated with antivirals and have shed influenza virus for a prolonged period. Isolation procedures should be instituted for all immunocompromised patients with influenza, both during and after therapy with amantadine or rimantadine.