ABSTRACT
OBJECTIVES: Prevention strategies implemented by hospitals to reduce nosocomial transmission of SARS-CoV-2 sometimes failed. Our aim was to determine the risk factors for nosocomial COVID-19. PATIENTS AND METHODS: A case-control study was conducted (September 1, 2020-January 31, 2021) with adult patients hospitalized in medical or surgical units. Infants or patients hospitalized in ICU were excluded. Cases were patients with nosocomial COVID-19 (clinical symptoms and RT-PCR + for SARS-CoV-2 or RT-PCR + for SARS-CoV-2 with Ct ≤ 28 more than 5 days after admission); controls were patients without infection (RT-PCR- for SARS-CoV-2 > 5 days after admission). They were matched according to length of stay before diagnosis and period of admission. Analyses were performed with a conditional logistic regression. RESULTS: A total of 281 cases and 441 controls were included. In the bivariate analysis, cases were older (OR per 10 years: 1.22; 95%CI [1.10;1.36]), had more often shared a room (OR: 1.74; 95%CI [1.25;2.43]) or a risk factor for severe COVID-19 (OR: 1.94; 95%CI [1.09;3.45]), were more often hospitalized in medical units [OR: 1.59; 95%CI [1.12;2.25]), had higher exposure to contagious health care workers (HCW; OR per 1person-day: 1.12; 95%CI [1.08;1.17]) and patients (OR per 1 person-day: 1.11; 95%CI [1.08;1.14]) than controls. In an adjusted model, risk factors for nosocomial COVID-19 were exposure to contagious HCW (aOR per 1person-day: 1.08; 95%CI [1.03;1.14]) and to contagious patients (aOR per 1person-day: 1.10; 95%CI [1.07;1.13]). CONCLUSIONS: Exposure to contagious professionals and patients are the main risk factors for nosocomial COVID-19.
ABSTRACT
Introduction: During the COVID-19 pandemic, hospitals implemented infection prevention strategies to reduce nosocomial transmission. Nevertheless, these strategies sometimes failed and determination of risk factors of transmission is crucial. Objectives: Our main objective was to determine the risk factors of nosocomial Covid-19 at Grenoble Alpes University hospital (CHUGA). Methods: A case-control study was conducted at CHUGA. A retrospective data collection was performed between 01/09/2020 and 31/01/2021. Adults patients hospitalized in medicine or surgery units were included. Infants or patients hospitalized in ICU were excluded. Case patients were patients with a nosocomial Covid-19 (clinical symptoms and positive PCR for SARS-CoV-2 or positive PCR for SARSCoV- 2 ≤ 28CT);control patients were patients without infection (negative PCR for SARS-CoV-2). They were matched by their length of stay and their period of admission. Bivariate and multivariate analysis were performed with a conditional logistic regression by Stata 12.0. Results: A total of 1393 patients with Covid-19 were hospitalized;722 patients were included in the case-control analysis ( ncase = 281;ncontrol = 441). In bivariate analysis, case patients were significantly older (OR:1.25;CI95% [1.12;1.40]), had more often a roommate (OR:1.74;CI95% [1.23;2.43]), more often a co-infection (OR:1.73;CI95% [1.26;2.36]), more often a severity risk factor of Covid-19 (OR:2.06;CI95% [1.14;3.71]) and a higher Charlson comorbidity index (OR:1,09;CI95% [1,01;1,20] than control patients. In an adjusted model that included the admission in the emergency room and the existence of a severity risk factor, the risk factors of nosocomial Covid-19 were: older age (aOR:1.24 per 10 years;CI95% [1.08;4.41]), having a roommate (aOR:1.63;CI95% [1.14;2.33]), and having a co-infection (aOR:1.62;CI95% [1.17;2.26]). Conclusion: Older patients with co-infection hospitalized in a multiple room were more susceptible to nosocomial Covid-19. These preliminary results need to be consolidated taking into account exposition to contagious healthcare workers or contagious patients.
ABSTRACT
NutriCoviD30 est une étude nationale multicentrique apportant les premières données objectives observationnelles sur les symptômes, répercussions et interventions nutritionnelles, 30 j après hospitalisation des patients pour COVID-19. Après autorisation à démarrer l'étude de type 3 non interventionnelle (loi Jardé- NCT04365816) : détermination, à partir de la liste des sortants d'unités COVID, des patients à appeler 30 j après retour à domicile. Après information et non-opposition du patient, entretien téléphonique (avec aidant si besoin) pour recueil de données. Questionnaire comportant : informations sur séjour, poids et nutrition pendant hospitalisation, antécédents médicaux, symptômes ressentis de la maladie, évaluation de la prise alimentaire par échelle verbale/visuelle analogique SEFI® (Score d'Évaluation Facile des Ingesta), évolution du poids, alimentation et impact à 1 mois. Les patients inclus ont été hospitalisés entre le 2 mars et 19 mai 2020 dans 11 hôpitaux, répartis dans 6 CHU et 5 régions françaises. Les données de 403 patients (sur 945 potentiellement incluables) ont pu être analysées. Population : 63 % d'hommes, âge moyen = 62,2 ± 14,2 ans, IMC moyen = 28,8 ± 5,3 kg/m2. Vingt pour cent des patients vivaient seuls, 2 % en EHPA/EHPAD, 78 % à plusieurs. Durée médiane [interquartile] de séjour = 13 j [8 ;20], dont 30 % de passage en réanimation (médiane = 11 j [6 ;20]) et 26 % en SSR. Assistance ventilatoire : 20 % sans O2, 34 % avec O2 < 3 L/min, 27 % avec O2 > 3 L/min, 19 %intubation. Quatre-vingt pour cent avaient au moins 1 maladie chronique. Les médianes de SEFI® étaient de 2,5/10 [1 ;5] au plus mal (T1) pendant durée moyenne 10 j ± 8 ;de 7,5 [5 ;0] à la sortie de l'hôpital (T2) et 10 [8 ;10] à 1 mois de la sortie (T3). Le SEFI® change significativement avec le temps : +3,5 [2 ;6] entre T1–T2, +6 [3 ;8] entre T1–T3. Le poids moyen était 83,4 ± 17,3 kg avant la maladie, 77,0 ± 15,8 kg à l'hôpital et 78,9 ± 15,4 kg à 1 mois de la sortie : soit perte de poids moyenne significative de 8 % du poids d'origine (−6,5 kg poids brut) durant l'hospitalisation et gain de poids significatif de 4 % à 1 mois après la sortie (p < 0,001). Cinquante-sept pour cent des patients font habituellement attention à leur poids (dont 40 % pour perdre) et 42 % à leur alimentation (dont 23 % restrictive ou « sans »). Parmi les patients qui n'ont pas récupéré leur poids à 1 mois, 62 % invoquent une raison volontaire. Vingt-neuf pour cent des patients ont été en contact avec un diététicien ou médecin nutritionniste à l'hôpital, 24 % après leur sortie. Quarante-sept pour cent déclarent avoir eu une alimentation orale adaptée, 51 % des compléments nutritionnels oraux à l'hôpital, 8 % à la sortie. On retrouve 14 % de nutrition entérale et 6 % parentérale. À 1 mois de la sortie, 4 % ont altéré leur alimentation, 16 % adaptée, 18 % équilibrée, 63 %retrouvé une prise alimentaire habituelle. Une très grande fatigue reste le signe persistant pour 34 %. Ces résultats vont permettre d'orienter les prises en charge, la prévention de la dénutrition et argumenter en faveur des recommandations des sociétés savantes. [ABSTRACT FROM AUTHOR] Copyright of Nutrition Clinique et Metabolisme is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)