Epidemiology and risk factors of nosocomial infections in a Chinese tertiary-care hospital: a 10-year retrospective case–control study

Abstract

Background

Nosocomial infections (NIs) are the most frequent adverse events among patients and cause a heavy burden on both health and economics. To investigate epidemiology of NIs and identify risk factors for NIs by integrating continuous long-term surveillance data.

Methods

We performed an observational study among inpatients at the Chinese People’s Liberation Army General Hospital between January 1, 2010, and December 31, 2019. Infection rates, mortality rates and percentage of NIs were calculated. Trends of yearly infection rates by pathogens were assessed using Mann-Kendall trend test. Controls were matched to cases (2:1) by age (±2 years), sex, admission date (±1 year) and admission diagnosis, and conditional logistic regression was used to estimate odds ratios.

Results

A total of 1,534,713 inpatients were included among which 33,468 NIs cases occurred with an infection rate of 2.18%. The most common infections were respiratory system infection (52.22%), bloodstream infection (17.60%), and genitourinary system infection (15.62%). Acinetobacter. baumannii (9.6%), Klebsiella. pneumoniae (9.0%), Pseudomonas. aeruginosa (8.6%), Escherichia. coli (8.6%) and Enterococcus. faecium (5.0%) were the top five isolated pathogens. Infection rates of K. pneumoniae and carbapenems-resistant K. pneumoniae significantly increased. Prior ICU stay, surgery, any device placement (including central venous catheter, mechanical ventilation, urinary catheter, and tracheotomy), prior use of triple or more antibiotics combinations, carbapenem, and β-Lactamase inhibitors were significantly associated with NIs.

Conclusion

K. pneumoniae has the potential to cause a clinical crisis with increasing infection rates and carbapenem resistance. Clinical management of invasive operations and antibiotics use should be further strengthened.

Keywords:

• Nosocomial infection
• carbapenems-resistant K. pneumoniae
• prophylactic antibiotics use
• invasive operations
• surveillance

Acknowledgements

Thanks for the support of Global Health and Infectious Diseases Group, Peking University, Beijing 100191, P. R. China. This work was supported by the National Key Research and Development Program of China [grant number 2021YFC0863400]. The funders had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Author contributions

Zekun Wang: Conceptualization, Methodology, Formal analysis, Software, Visualisation, Writing-Original draft preparation. Mingmei Du: Conceptualization, Methodology, Formal analysis, Data curation, Investigation, Writing-Original draft preparation. Hui Cao: Formal analysis, Software. Huiling Geng: Formal analysis, Software. Hongwu Yao: Data curation, Investigation, Validation. Bowei Liu: Data curation, Investigation, Validation. Yanling Bai: Data curation, Investigation, Validation. Zhongwei Jia: Conceptualization, Funding acquisition, Project administration, Supervision, Writing-review and editing. Yunxi Liu: Conceptualization, Project administration, Supervision, Resources, Writing-review & editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The original data inquiries can be directed to the corresponding authors.

Additional information

Funding

This work was supported by the National Key Research and Development Program of China [grant number 2021YFC0863400]. The funders had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.