A Systematic Review and Meta-Analysis of Inpatient Mortality Associated With Nosocomial and Community COVID-19 Exposes the Vulnerability of Immunosuppressed Adults

BackgroundLittle is known about the mortality of hospital-acquired (nosocomial) COVID-19 infection globally. We investigated the risk of mortality and critical care admission in hospitalised adults with nosocomial COVID-19, relative to adults requiring hospitalisation due to community-acquired infection.MethodsWe systematically reviewed the peer-reviewed and pre-print literature from 1/1/2020 to 9/2/2021 without language restriction for studies reporting outcomes of nosocomial and community-acquired COVID-19. We performed a random effects meta-analysis (MA) to estimate the 1) relative risk of death and 2) critical care admission, stratifying studies by patient cohort characteristics and nosocomial case definition.Results21 studies were included in the primary MA, describing 8,251 admissions across 8 countries during the first wave, comprising 1513 probable or definite nosocomial COVID-19, and 6738 community-acquired cases. Across all studies, the risk of mortality was 1.3 times greater in patients with nosocomial infection, compared to community-acquired (95% CI: 1.005 to 1.683). Rates of critical care admission were similar between groups (Relative Risk, RR=0.74, 95% CI: 0.50 to 1.08). Immunosuppressed patients diagnosed with nosocomial COVID-19 were twice as likely to die in hospital as those admitted with community-acquired infection (RR=2.14, 95% CI: 1.76 to 2.61).ConclusionsAdults who acquire SARS-CoV-2 whilst already hospitalised are at greater risk of mortality compared to patients admitted following community-acquired infection; this finding is largely driven by a substantially increased risk of death in individuals with malignancy or who had undergone transplantation. These findings inform public health and infection control policy and argue for individualised clinical interventions to combat the threat of nosocomial COVID-19, particularly for immunosuppressed groups.Systematic Review RegistrationPROSPERO CRD42021249023

A systematic review and meta-analysis of inpatient mortality associated with nosocomial and community COVID-19 exposes the vulnerability of immunosuppressed adults

Background: Little is known about the mortality of hospital-acquired (nosocomial) COVID-19 infection globally. We investigated the risk of mortality and critical care admission in hospitalised adults with nosocomial COVID-19, relative to adults requiring hospitalisation due to community-acquired infection. Methods: We systematically reviewed the peer-reviewed and pre-print literature from 1/1/2020 to 9/2/2021 without language restriction for studies reporting outcomes of nosocomial and community-acquired COVID-19. We performed a random effects meta-analysis (MA) to estimate the 1) relative risk of death and 2) critical care admission, stratifying studies by patient cohort characteristics and nosocomial case definition. Results: 21 studies were included in the primary MA, describing 8,246 admissions across 8 countries during the first wave, comprising 1517 probable or definite nosocomial COVID-19, and 6729 community-acquired cases. Across all studies, the risk of mortality was 1.31 times greater in patients with nosocomial infection, compared to community-acquired (95% CI: 1.01 to 1.70). Rates of critical care admission were similar between groups (Relative Risk, RR=0.74, 95% CI: 0.50 to 1.08). Immunosuppressed patients diagnosed with nosocomial COVID-19 were twice as likely to die in hospital as those admitted with community-acquired infection (RR=2.14, 95% CI: 1.76 to 2.61). Conclusions: Adults who acquire SARS-CoV-2 whilst already hospitalised are at greater risk of mortality compared to patients admitted following community-acquired infection; this finding is largely driven by a substantially increased risk of death in individuals with malignancy or who had undergone transplantation. These findings inform public health and infection control policy, and argue for individualised clinical interventions to combat the threat of nosocomial COVID-19, particularly for immunosuppressed groups. Systematic review registration: PROSPERO CRD42021249023

Current status of community-acquired infection of COVID-19 in delivery facilities in Japan

A nationwide questionnaire survey about community-acquired infection of coronavirus disease 2019 (COVID-19) was conducted in July 2020 to identify the characteristics of and measures taken by Japanese medical facilities providing maternity services. A case-control study was conducted by including medical facilities with (Cases) and without (Control) community-acquired infection of COVID-19. Responses from 711 hospitals and 707 private clinics were assessed (72% of all hospital and 59% all private clinics provided maternity service in Japan). Seventy-five COVID-19-positive pregnant women were treated in 52 facilities. Community-acquired infection was reported in 4.1% of the facilities. Of these, 95% occurred in the hospital. Nine patients developed a community-acquired infection in the maternity ward or obstetric department. Variables that associated with community-acquired infection of COVID-19 (adjusted odds ratio [95% confidence interval]) were found to be state of emergency prefecture (4.93 [2.17–11.16]), PCR test for SARS-CoV-2 on admission (2.88 [1.59–5.24]), and facility that cannot treat COVID-19 positive patients (0.34 [0.14–0.82]). In conclusion, community-acquired infection is likely to occur in large hospitals that treat a higher number of patients than private clinics do, regardless of the preventive measures used.

Accuracy of SOFA Score to Predict Outcome in Community-Acquired Sepsis

Background: The new definition of Sepsis-3 defines sepsis as life-threatening organ dysfunction, demonstrated by an increase in the Sequential Organ Failure Assessment (SOFA) of 2 or more points, caused by a dysregulated host response to infection. The performance of SOFA score data in a setting of a tertiary public hospital in a middle-income country remains limited. Objective: To determine the accuracy of the SOFA score to predict the 28-day mortality in community-acquired sepsis patients. Materials and Methods: A retrospective study enrolled community-acquired sepsis and septic shock patients admitted between January and December 2015 in Hatyai Hospital, a tertiary public Hospital in Southern Thailand. All variables for calculating the SOFA and qSOFA scores were collected. The primary outcome was the 28-day mortality. Results: Three hundred seventy-nine patients were enrolled. Eighty-seven patients (23%) died. The median (IQR) SOFA score was 6 (3, 9) points. The SOFA score had a fair predictive performance (AUROC 0.71, 95% CI 0.65 to 0.77), which was higher than qSOFA score (AUROC 0.67, 95% CI 0.62 to 0.73). The SOFA score of 2 points associated with mortality (13%) and higher score patients had an incremental increase mortality rate. The hazard ratio (HR) was 4.59 (95% Cl 1.3 to 15.78, p=0.02) for SOFA Score 6 to 7 points. Conclusion: Among patients presenting with community-acquired infection, the SOFA score indicated the fair predicting ability for the 28-day mortality and performed better than qSOFA score. Keywords: SOFA, qSOFA, Sepsis, Accuracy, Mortality, Community-acquired infection, Thailand

Strategi Pencegahan dan Pengendalian Dalam Upaya Pemutusan Rantai Infeksi di Rumah Sakit

Rumah sakit sebagai salah satu sarana kesehatan yang memberikan pelayanan kesehatan kepada masyarakat, memiliki peran yang sangat penting dalam meningkatkan derajat kesehatan masyarakat, dengan melaksanakan upaya kesehatan yang berhasil guna dan berdaya guna terhadap pelayanan masyarakat, oleh karena itu rumah sakit dituntut untuk dapat memberikan pelayanan yang bermutu sesuai dengan standar yang telah ditentukan. Hal yang masih menjadi keresahan dalam rangka meningkatan kualitas pelayanan kesehatan ialah adanya Infeksi. Penyakit infeksi masih merupakan salah satu masalah kesehatan di dunia, termasuk Indonesia. Ditinjau dari asal atau didapatnya infeksi dapat berasal dari komunitas (Community Acquired Infection) atau berasal dari lingkungan pelayanan kesehatan atau klinik. Sarana pelayanan kesehatan wajib memberikan jaminan keamanan kesehatan baik bagi tenaga kesehatan maupun masyarakat yang dilayani. Penyebaran penyakit menular telah meningkatkan kekhawatiran masyarakat maupun petugas kesehatan dalam beberapa dekade terakhir akibat munculnya infeksi.Prinsip penting dari keberadaan institusi pelayanan kesehatan berkualitas adalah perlindungan bagi pasien, tenaga kesehatan, tenaga pendukung dan komunitas masyarakat di sekitarnya dari penularan infeksi. Hal ini dapat diwujudkan dengan penerapan Pencegahan dan Pengendalian Infeksi yang efektif dan efisien.Perawat berperan penting sebagai pemutus rantai infeksi untuk menurunkan angka kejadian infeksi yang didapat di rumah sakit (HAIs). Penelitian deskriptif korelatif ini bertujuan untuk mendapatkan gambaran pengaruh karakteristik, peran kepemimpinan, dan fungsi manajemen kepala ruang terhadap perilaku perawat dalam memutus rantai infeksi. Tenaga medis harus waspada dalam menerapkan berbagai metode pencegahanuntuk mengendalikan berbagai patogen di semua lingkungan pelayanan kesehatan, bukan hanya di rumah sakit.

Community-acquired infection caused by the uncommon hypervirulent Klebsiella pneumoniae ST66-K2 lineage

Klebsiella pneumoniae (Kp) reference strain Kp52.145 is widely used in experimental Klebsiella pathophysiology. Since 1935, only one other strain of the same sublineage (sequence type ST66, capsular serotype K2) was isolated (AJ210, Australia). Here, we describe a community-acquired invasive infection caused by a ST66-K2 Kp strain in France. Four hypermucoviscous Kp isolates responsible for acute otitis media, meningitis, bacteraemia and bacteriuria, respectively, were obtained from a patient with a history of chronic alcoholism and diabetes mellitus, and infected with HIV. The isolates were characterized by phenotypic and genomic methods. The four genetically identical ST66-K2 isolates presented a full antimicrobial susceptibility profile, including to ampicillin, corresponding to a single strain (SB5881), which was more closely related to AJ210 (135 SNPs) than to Kp52.145 (388 SNPs). Colibactin and yersiniabactin gene clusters were present on the integrative and conjugative element ICEKp10 in the chromosome. The two plasmids from Kp52.145 were detected in SB5881. In addition to carrying genes for virulence factors RmpA, aerobactin and salmochelin, plasmid II has acquired in SB5881, the conjugation machinery gene cluster from plasmid I. We report the first case of community-acquired infection caused by a hypervirulent ST66-K2 Kp strain in Europe. This demonstrates the long-term persistence of the high-virulence and laboratory model ST66-K2 sublineage. The combination of a conjugative apparatus and major virulence genes on a single plasmid may contribute to the co-occurrence of hypervirulence and multidrug resistance in single Kp strains.