透析中心内 SARS-CoV-2 传播的网络分析：一项多中心网络分析。

Network analysis of spread of SARS-CoV-2 within dialysis clinics: A multi-center network analysis.

机构信息

Department of Statistics and Applied Probability, University of California, Santa Barbara, Santa Barbara, California, United States of America.

Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.

出版信息

PLoS One. 2024 Mar 8;19(3):e0299855. doi: 10.1371/journal.pone.0299855. eCollection 2024.

DOI:10.1371/journal.pone.0299855

PMID:38457465

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10923420/

Abstract

BACKGROUND

In-center hemodialysis entails repeated interactions between patients and clinic staff, potentially facilitating the spread of COVID-19. We examined if in-center hemodialysis is associated with the spread of SARS-CoV-2 between patients.

METHODS

Our retrospective analysis comprised all patients receiving hemodialysis in four New York City clinics between March 12th, 2020, and August 31st, 2022. Treatment-level clinic ID, dialysis shift, dialysis machine station, and date of COVID-19 diagnosis by RT-PCR were documented. To estimate the donor-to-potential recipient exposure ("donor" being the COVID-19 positive patient denoted as "COV-Pos"; "potential recipient" being other susceptible patients in the same shift), we obtained the spatial coordinates of each dialysis station, calculated the Euclidean distances between stations and weighted the exposure by proximity between them. For each donor, we estimated the donor-to-potential recipient exposure of all potential recipients dialyzed in the same shift and accumulated the exposure over time within the 'COV-Pos infectious period' as cumulative exposures. The 'COV-Pos infectious period' started 5 days before COVID-19 diagnosis date. We deployed network analysis to assess these interactions and summarized the donor-to-potential recipient exposure in 193 network diagrams. We fitted mixed effects logistic regression models to test whether more donor-to-potential recipient exposure conferred a higher risk of SARS-CoV-2 infection.

RESULTS

Out of 978 patients, 193 (19.7%) tested positive for COVID-19 and had contact with other patients during the COV-Pos infectious period. Network diagrams showed no evidence that more exposed patients would have had a higher chance of infection. This finding was corroborated by logistic mixed effect regression (donor-to-potential recipient exposure OR: 0.63; 95% CI 0.32 to 1.17, p = 0.163). Separate analyses according to vaccination led to materially identical results.

CONCLUSIONS

Transmission of SARS-CoV-2 between in-center hemodialysis patients is unlikely. This finding supports the effectiveness of non-pharmaceutical interventions, such as universal masking and other procedures to control spread of COVID-19.

摘要

背景

中心血液透析需要患者与诊所工作人员反复互动，这可能会增加 COVID-19 的传播风险。我们研究了中心血液透析是否与 SARS-CoV-2 在患者之间的传播有关。

方法

我们的回顾性分析包括 2020 年 3 月 12 日至 2022 年 8 月 31 日期间在纽约市四家诊所接受血液透析的所有患者。记录了治疗层面的诊所 ID、透析班次、透析机站以及通过 RT-PCR 诊断 COVID-19 的日期。为了估计供体到潜在受体的暴露（供体是 COVID-19 阳性患者，记为“COV-Pos”；潜在受体是同一班次的其他易感患者），我们获取了每个透析站的空间坐标，计算了站与站之间的欧几里得距离，并根据它们之间的接近程度对暴露进行加权。对于每个供体，我们估计了同一班次中所有潜在受体的供体到潜在受体的暴露，并在“COV-Pos 感染期”内随着时间的推移累积暴露。“COV-Pos 感染期”从 COVID-19 诊断日期前 5 天开始。我们使用网络分析来评估这些相互作用，并在 193 个网络图表中总结了供体到潜在受体的暴露情况。我们拟合了混合效应逻辑回归模型，以检验更多的供体到潜在受体的暴露是否会增加 SARS-CoV-2 感染的风险。

结果

在 978 名患者中，有 193 名（19.7%）COVID-19 检测呈阳性，并在“COV-Pos 感染期”内与其他患者接触。网络图表没有显示暴露程度更高的患者感染的机会更高。逻辑混合效应回归（供体到潜在受体的暴露比：0.63；95%CI：0.32 至 1.17，p=0.163）证实了这一发现。根据疫苗接种情况进行的单独分析得出了几乎相同的结果。