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Factors associated with in-hospital death in patients with nosocomial infections: a registry-based study using community data in western Iran
Salman Khazaei, Erfan Ayubi, Ensiyeh Jenabi, Saeid Bashirian, Masud Shojaeian, Leili Tapak
Epidemiol Health. 2020;42:e2020037.   Published online June 1, 2020
DOI: https://doi.org/10.4178/epih.e2020037
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  • 268 Download
  • 2 Web of Science
  • 6 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
Objectives
Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections.
Methods
This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models.
Results
In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females).
Conclusion
We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.
Summary

Citations

Citations to this article as recorded by  
  • Predictors of In-ICU Mortality Among Older Patients with Healthcare-Associated Infection: A Cohort Study
    Fereshteh Rezaie, Farahnaz Mohammadi-Shahboulaghi, Reza Fadayevatan, Mohsen Shati, Gholamreza Ghaedamini Harouni
    Journal of Kermanshah University of Medical Sciences.2023;[Epub]     CrossRef
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    MGM Journal of Medical Sciences.2023; 10(4): 667.     CrossRef
  • Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis
    Sima Rafiei, Zahra Nejatifar, Rana Soheylirad, Samira Raoofi, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee
    Journal of Health Reports and Technology.2022;[Epub]     CrossRef
  • Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis
    Sima Rafiei, Zahra Nejatifar, Rana Soheylirad, Samira Raoofi, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee
    Journal of Health Reports and Technology.2022;[Epub]     CrossRef
  • The Impact of COVID-19 Outbreak on Nosocomial Infection Rate: A Case of Iran
    Maryam Jabarpour, Mahlagha Dehghan, Giti Afsharipour, Elham Hajipour Abaee, Parvin Mangolian Shahrbabaki, Mehdi Ahmadinejad, Mahboobeh Maazallahi, Aseer Manilal
    Canadian Journal of Infectious Diseases and Medical Microbiology.2021; 2021: 1.     CrossRef
  • Survival rate in patients with ICU-acquired infections and its related factors in Iran’s hospitals
    MEDSKorosh Etemad, Yousef Khani, Seyed-Saeed Hashemi-Nazari, Neda Izadi, Babak Eshrati, Yadollah Mehrabi
    BMC Public Health.2021;[Epub]     CrossRef
Asymptomatic Middle East Respiratory Syndrome coronavirus infection using a serologic survey in Korea
Yeong-jun Song, Jeong-Sun Yang, Hee Jung Yoon, Hae-Sung Nam, Soon Young Lee, Hae-Kwan Cheong, Woo-Jung Park, Sung Han Park, Bo Youl Choi, Sung Soon Kim, Moran Ki
Epidemiol Health. 2018;40:e2018014.   Published online April 15, 2018
DOI: https://doi.org/10.4178/epih.e2018014
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  • 301 Download
  • 15 Web of Science
  • 16 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The rates of asymptomatic infection with Middle East Respiratory Syndrome (MERS) coronavirus vary. A serologic study was conducted to determine the asymptomatic MERS infection rate in healthcare workers and non-healthcare workers by exposure status.
METHODS
Study participants were selected from contacts of MERS patients based on a priority system in 4 regions strongly affected by the 2015 MERS outbreak. A sero-epidemiological survey was performed in 1,610 contacts (average duration from exposure to test, 4.8 months), and the collected sera were tested using an enzyme-linked immunespecific assay (ELISA), immunofluorescence assay (IFA), and plaque reduction neutralization antibody test (PRNT). Among the 1,610 contacts, there were 7 ELISA-positive cases, of which 1 exhibited positive IFA and PRNT results.
RESULTS
The asymptomatic infection rate was 0.060% (95% confidence interval, 0.002 to 0.346). The asymptomatic MERS case was a patient who had been hospitalized with patient zero on the same floor of the hospital at the same time. The case was quarantined at home for 2 weeks after discharge, and had underlying diseases, including hypertension, angina, and degenerative arthritis.
CONCLUSIONS
The asymptomatic infection was acquired via healthcare-associated transmission. Thus, it is necessary to extend serologic studies to include inpatient contacts who have no symptoms.
Summary
Korean summary
2015년 국내 MERS 유행시에 자가격리를 시행하였던 접촉자 약 15,000명 (의료인과 비의료인 포함) 중에서 주요 유행지역, 노출 강도 등을 고려하여 선별된 3,291명을 대상으로 무증상 감염여부를 확인하기 위한 혈청 역학조사를 수행하였다. 최종 검사에 참여한 1,610명 중에서 7명이 ELISA 양성 반응을 보였고, 그 중 1명이 IFA와 PRNT에서도 양성 반응을 보여 무증상 감염률은 0.060%(95% CI: 0.002-0.346)로 기존 연구에 비하여 낮았다. 최종 양성을 보인 1명은 노출 당시 1번환자와 가까운 병실에 입원하였던 환자였다.

Citations

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  • MERS-CoV seroconversion amongst Malaysian Hajj pilgrims returning from the Middle East, 2016–2018: results from the MERCURIAL multiyear prospective cohort study
    Jefree Johari, Robert D. Hontz, Brian L. Pike, Tupur Husain, Norhayati Rusli, Rozainanee Mohd-Zain, Vunjia Tiong, Hai-Yen Lee, Boon-Teong Teoh, Sing-Sin Sam, Chee-Sieng Khor, Shih-Keng Loong, Juraina Abd-Jamil, Siti-Sarah Nor'e, Hasmawati Yahaya, Naim Che
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    Afnan A. Degnah, Sawsan S. Al-amri, Ahmed M. Hassan, Abdulrahman S. Almasoud, Manar Mousa, Sarah A. Almahboub, Rowa Y. Alhabbab, Ahmed A. Mirza, Salwa I. Hindawi, Naif Khalaf Alharbi, Esam I. Azhar, Anwar M. Hashem
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    Jang-Hoon Choi, Hye-Min Woo, Tae-young Lee, So-young Lee, Sang-Mu Shim, Woo-Jung Park, Jeong-Sun Yang, Joo Ae Kim, Mi-Ran Yun, Dae-Won Kim, Sung Soon Kim, Yi Zhang, Wei Shi, Lingshu Wang, Barney S. Graham, John R. Mascola, Nanshuang Wang, Jason S. McLella
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    Dong Zhao, Mengmei Wang, Ming Wang, Yang Zhao, Zhishui Zheng, Xiaochen Li, Yunting Zhang, Tao Wang, Shaolin Zeng, Weihua Hu, Wenzhen Yu, Ke Hu
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    Jaffar A. Al-Tawfiq, Philippe Gautret
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    Seongmin Jo, Jinkwan Hong, Sang-Eun Lee, Moran Ki, Bo Youl Choi, Minki Sung
    Royal Society Open Science.2019; 6(3): 181164.     CrossRef
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    Sibylle Bernard-Stoecklin, Birgit Nikolay, Abdullah Assiri, Abdul Aziz Bin Saeed, Peter Karim Ben Embarek, Hassan El Bushra, Moran Ki, Mamunur Rahman Malik, Arnaud Fontanet, Simon Cauchemez, Maria D. Van Kerkhove
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    Minki Sung, Seongmin Jo, Sang-Eun Lee, Moran Ki, Bo Youl Choi, JinKwan Hong
    International Journal of Environmental Research and Public Health.2018; 15(12): 2757.     CrossRef
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MERS-Original Article
Epidemiologic features of the first MERS outbreak in Korea: focus on Pyeongtaek St. Mary’s Hospital
Kyung Min Kim, Moran Ki, Sung-il Cho, Minki Sung, Jin Kwan Hong, Hae-Kwan Cheong, Jong-Hun Kim, Sang-Eun Lee, Changhwan Lee, Keon-Joo Lee, Yong-Shik Park, Seung Woo Kim, Bo Youl Choi
Epidemiol Health. 2015;37:e2015041.   Published online September 17, 2015
DOI: https://doi.org/10.4178/epih/e2015041
  • 22,905 View
  • 278 Download
  • 30 Web of Science
  • 29 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the epidemiologic features of the confirmed cases of Middle East Respiratory Syndrome (MERS) in Pyeongtaek St. Mary’s Hospital, where the outbreak first began, in order to identify lessons relevant for the prevention and control of future outbreaks.
METHODS
The patients’ clinical symptoms and test results were collected from their medical records. The caregivers of patients were identified by phone calls.
RESULTS
After patient zero (case #1) was admitted to Pyeongtaek St. Mary’s Hospital (May 15-May 17), an outbreak occurred, with 36 cases between May 18 and June 4, 2015. Six patients died (fatality rate, 16.7%). Twenty-six cases occurred in the first-generation, and 10 in the second-generation. The median incubation period was five days, while the median period from symptom onset to death was 12.5 days. While the total attack rate was 3.9%, the attack rate among inpatients was 7.6%, and the inpatients on the eighth floor, where patient zero was hospitalized, had an 18.6% attack rate. In contrast, caregivers and medical staff showed attack rates of 3.3% and 1.1%, respectively.
CONCLUSIONS
The attack rates were higher than those of the previous outbreaks in other countries. The outbreak spread beyond Pyeongtaek St. Mary’s Hospital when four of the patients were moved to other hospitals without appropriate quarantine. The best method of preventing future outbreaks is to overcome the vulnerabilities observed in this outbreak, such as ward crowding, patient migration without appropriate data sharing, and the lack of an initial broad quarantine.
Summary
Korean summary
평택성모병원에서는 총 36명의 메르스 환자가 발생하여 이중 6명이 사망하였다. 또한 평택성모병원 유행의 발병률은 기존에 알려진 것보다 높았다. 한국의 메르스 유행이 시작된 평택성모병원에서 나타난 초기 방역 부족, 적절한 정보공유 없이 환자들이 병원간에 이동하는 것, 혼잡한 병동 문제 등의 감염병 전파 취약점을 극복하는 것이 향후 새로운 감염병 유행을 막을 수 있는 최선의 방법이 될 것이다.

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Original Article
An Epidemiologic Study on the Nosocomial Bloodstream Infection in Two Hospitals.
Mi Jeung Ahn, Chang Kyu Lee, Chae Seung Lim, You Cheol Shin, Soon Duck Kim
Korean J Epidemiol. 2001;23(2):33-43.
  • 5,297 View
  • 14 Download
AbstractAbstract PDF
Abstract
PURPOSE
In this study, nosocomial bloodstream infection rate and fatality rate for 774 and 386 patients, who whose blood cultivation were obtained after 48 hours of hospitalization between March 1999 and February 2000 in two university hospitals, were sought. A distribution of etiologic agent and risk factors of the nosocoial bloodstream infection were also investigated.
METHODS
This study was carried out through medical record review and a structural questionnaire. Besides registers of microbe cultivation in the department of clinical pathology and medical records of patients were checked. The nosocomial bloodstream infection was also checked through medical records of patients using the standard of CDC. Statistical analysis were performed using SAS 6.12.
RESULTS
The nosocomial bloodstream infection rate in hospital K and hospital A were 3.9 and 3.5 per 1,000 discharged patients, respectively. Although the rates were increased accoding to patients' age, they were different by medical departments, showing the highest level in the ICU. The fatality rate from nosocomial bloodstream infection in hospital K and hospital A were 12.5% and 21.8%, respectively. A distribution of etiologic agent of the nosocomial bloodstream infection in hospital K was 17 cases(21.8%) of Coagulase negative staphylococcus(CNS), 12 cases(15.0%) of Staphylococcus aureus and 8 cases(10.0%) of Enterococcus spp. For hospital A, it was 14 cases925.4%) of Coagulase negative taphylococcus(CNS), 9 cases(16.4%) of Staphylococcus aureus and 7 cases(12.7%) of Klebsiella pneumoniae. While risk factors of the nosocomial bloodstream infection edentified in hospital K were ICU, intracranial injury and hospitalization period, those for hospital A were a use of the central nenous tube, intracranial injury and hospitalization period.
CONCLUSION
It is expected that nosocomial bloodstream infection increases as aged group increases by the change of the population structure, as the usage of invasive instrument increases by development of new medical instrument as well as large scale hospitals. For these reasons, further studies developing countermeasures against nosocomial bloodstream infection are recommended.
Summary

Epidemiol Health : Epidemiology and Health