Almeida Francisco, Correia Sofia, Leal Cátia, Guedes Mariana, Duro Raquel, Andrade Paulo, Pedrosa Afonso, Rocha-Pereira Nuno, Lima-Alves Carlos, Azevedo Ana
Unidade de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos, Centro de Epidemiologia Hospitalar, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal.
J Clin Med. 2024 Sep 5;13(17):5251. doi: 10.3390/jcm13175251.
Knowledge of the role of hospital conditions in SARS-CoV-2 transmission should inform strategies for the prevention of nosocomial spread of this pathogen and of similarly transmitted viruses. This study aimed to identify risk factors for nosocomial acquisition of SARS-CoV-2. We ran a nested case-control study with incidence density sampling among adult patients hospitalized for >7 days (August-December 2020). Patients testing positive for SARS-CoV-2 after the 7th day of hospitalization were defined as cases and matched with controls (1:4) by date of admission, hospitalization duration until index date, and type of department. Individual and contextual characteristics were gathered, including admission characteristics and exposures during the risk period. Conditional logistic regression was used to estimate the odds ratios (ORs) with respective 95% confidence intervals (CI) separately for probable (diagnosed on day 8-13) and definitive (diagnosed after day 14) nosocomial sets. We identified 65 cases (31 probable; 34 definitive) and 219 controls. No individual characteristic was related to nosocomial acquisition of SARS-CoV-2. Contextual risk factors for nosocomial acquisition were staying in a non-refurbished room (probable nosocomial: OR = 3.6, 1.18-10.87), contact with roommates with newly diagnosed SARS-CoV-2 (probable nosocomial: OR = 9.9, 2.11-46.55; definitive nosocomial: OR = 3.4, 1.09-10.30), and contact with roommates with a first positive test 21-90 days before the beginning of contact (probable nosocomial: OR = 10.7, 1.97-57.7). Hospital conditions and contact with recently infected patients modulated nosocomial SARS-CoV-2 transmission. These results alert us to the importance of the physical context and of agile screening procedures to shorten contact with patients with recent infection.
了解医院环境在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）传播中的作用，应为预防该病原体及类似传播病毒的医院内传播策略提供依据。本研究旨在确定医院获得性SARS-CoV-2感染的危险因素。我们在2020年8月至12月期间对住院超过7天的成年患者进行了一项发病率密度抽样的巢式病例对照研究。住院第7天之后SARS-CoV-2检测呈阳性的患者被定义为病例，并按入院日期、至索引日期的住院时长和科室类型与对照（1:4）进行匹配。收集了个体和环境特征，包括入院特征和风险期内的暴露情况。分别针对可能（第8 - 13天确诊）和确诊（第14天之后确诊）的医院感染病例组，使用条件逻辑回归来估计优势比（OR）及其各自的95%置信区间（CI）。我们确定了65例病例（31例可能病例；34例确诊病例）和219例对照。没有个体特征与医院获得性SARS-CoV-2感染相关。医院获得性感染的环境危险因素包括住在未翻新的病房（可能的医院感染：OR = 3.6，1.18 - 10.87）、与新诊断为SARS-CoV-2的室友接触（可能的医院感染：OR = 9.9，2.11 - 46.55；确诊的医院感染：OR = 3.4，1.09 - 10.30）以及与在接触开始前21 - 90天首次检测呈阳性的室友接触（可能的医院感染：OR = 10.7，1.97 - 57.7）。医院环境和与近期感染患者的接触会调节医院内SARS-CoV-2的传播。这些结果提醒我们注意物理环境和灵活筛查程序对于缩短与近期感染患者接触时间的重要性。
