Department of Infectiology and Infection Prevention, Helios Klinikum Duisburg, Duisburg, Germany; Center for Clinical and Translational Research, Helios Universitätsklinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany.
Heart Centre Leipzig at University of Leipzig and Helios Health Institute, Berlin, Germany.
J Hosp Infect. 2022 Nov;129:82-88. doi: 10.1016/j.jhin.2022.08.004. Epub 2022 Aug 20.
Avoiding in-hospital transmissions has been crucial in the COVID-19 pandemic. Little is known on the extent to which hospital-acquired SARS-CoV-2 variants have caused infections in Germany.
To analyse the occurrence and the outcomes of HAI with regard to different SARS-CoV-2 variants.
Patients with SARS-CoV-2 infections hospitalized between March 1, 2020 and May 17, 2022 in 79 hospitals of the Helios Group were included. Information on patients' characteristics and outcomes were retrieved from claims data. In accordance with the Robert Koch Institute, infections were classified as hospital-acquired when tested positive >6 days after admission and if no information hinted at a different source.
In all, 62,875 SARS-CoV-2 patients were analysed, of whom 10.6% had HAI. HAIs represented 14.7% of SARS-CoV-2 inpatients during the Wildtype period, 3.5% during Alpha (odds ratio: 0.21; 95% confidence interval: 0.19-0.24), 8.8% during Delta (2.70; 2.35-3.09) and 10.1% during Omicron (1.10; 1.03-1.19). When age and comorbidities were accounted for, HAI had lower odds for death than community-acquired infections (0.802; 0.740-0.866). Compared to the Wildtype period, HAIs during Omicron were associated with lower odds for ICU (0.78; 0.69-0.88), ventilation (0.47; 0.39-0.56), and death (0.33; 0.28-0.40).
Hospital-acquired SARS-CoV-2 infections occurred throughout the pandemic, affecting highly vulnerable patients. Although transmissibility increased with newer variants, the proportion of HAIs decreased, indicating improved infection prevention and/or the effect of immunization. Furthermore, the Omicron period was associated with improved outcomes. However, the burden of hospital-acquired SARS-CoV-2 infections remains high.
在 COVID-19 大流行期间，避免医院内传播至关重要。关于医院获得的 SARS-CoV-2 变体在德国造成感染的程度知之甚少。
分析不同 SARS-CoV-2 变体导致的医院获得性感染的发生和结局。
纳入 2020 年 3 月 1 日至 2022 年 5 月 17 日期间 Helios 集团 79 家医院收治的 SARS-CoV-2 感染住院患者。从索赔数据中检索患者特征和结局信息。根据罗伯特·科赫研究所的规定，如果检测结果为阳性且入院后 >6 天，且没有信息表明感染源不同，则将感染归类为医院获得性感染。
共分析了 62875 例 SARS-CoV-2 患者，其中 10.6%为医院获得性感染。在野生型时期，医院获得性感染占 SARS-CoV-2 住院患者的 14.7%，在 Alpha 时期占 3.5%（优势比：0.21；95%置信区间：0.19-0.24），在 Delta 时期占 8.8%（2.70；2.35-3.09），在奥密克戎时期占 10.1%（1.10；1.03-1.19）。当考虑年龄和合并症时，医院获得性感染的死亡风险低于社区获得性感染（0.802；0.740-0.866）。与野生型时期相比，奥密克戎时期的医院获得性感染与 ICU（0.78；0.69-0.88）、呼吸机（0.47；0.39-0.56）和死亡（0.33；0.28-0.40）的几率较低相关。
在整个大流行期间，医院获得性 SARS-CoV-2 感染一直在发生，影响到高度脆弱的患者。尽管随着新变体的传播，传染性有所增加，但医院获得性感染的比例有所下降，这表明感染预防措施得到了改善，或者免疫接种的效果。此外，奥密克戎时期的结局有所改善。然而，医院获得性 SARS-CoV-2 感染的负担仍然很高。
