The contribution of hospital-acquired infections to the COVID-19 epidemic in England in the first half of 2020
The contribution of hospital-acquired infections to the COVID-19 epidemic in England in the first half of 2020
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DOI：
10.1101/2021.09.02.21262480
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发表时间：
2021-09
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影响因子：
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通讯作者：
G. Knight;Thi Mui Pham;J. Stimson;Sebastian Funk;Y. Jafari;D. Pople;S. Evans;Mo Yin;Colin S.
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文献类型：
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作者：
G. Knight;Thi Mui Pham;J. Stimson;Sebastian Funk;Y. Jafari;D. Pople;S. Evans;Mo Yin;Colin S.
背景SARS-CoV-2在医院传播，但这些环境对国家层面整体COVID-19负担的贡献尚不清楚。方法我们使用全面的国家英语数据集和模拟建模来确定有症状的医院获得性感染的总负担（已确定和未确定）。那些未识别的患者可能是1）在症状发作前出院（“遗漏”），或2）症状发作在入院后7天或更短时间内（“错误分类”）。我们估计了2020年7月31日之前“错误分类”病例和“遗漏”症状感染传播对英国疫情的贡献。结果在我们的数据集中，有记录的症状发作日期的急性英国信托医院住院的COVID-19患者（n = 65，028），7%被归类为医院获得性（入院后8天或更长时间症状发作，出院前）。我们估计，只有30%（范围跨越数周和200模拟：20-41%）的症状性医院获得性感染将被确定。在目前被归类为社区获得性COVID-19的病例中，错误分类的病例和漏诊感染的传播可能占15%（平均95%，200次模拟范围：14.1%-15.8%）。据此，我们估计26，600（25，900至27，700）人在2020年7月31日之前在英格兰的一个急性信托中获得了有症状的SARS-CoV-2感染，导致15，900（15，200 - 16，400）或所有确定的住院COVID-19病例的20.1%（19.2%-20.7%）。结论SARS-CoV-2向住院患者的传播可能导致“第一波”中约五分之一的住院COVID-19病例，但不到英格兰所有SARS-CoV-2感染病例的1%。使用症状发作作为医院获得性SARS-CoV-2的检测方法可能会遗漏相当大比例（>60%）的医院获得性感染。
Background SARS-CoV-2 spreads in hospitals, but the contribution of these settings to the overall COVID-19 burden at a national level is unknown. Methods We used comprehensive national English datasets and simulation modelling to determine the total burden (identified and unidentified) of symptomatic hospital-acquired infections. Those unidentified would either be 1) discharged before symptom onset ("missed"), or 2) have symptom onset 7 days or fewer from admission ("misclassified"). We estimated the contribution of "misclassified" cases and transmission from "missed" symptomatic infections to the English epidemic before 31st July 2020. Findings In our dataset of hospitalised COVID-19 patients in acute English Trusts with a recorded symptom onset date (n = 65,028), 7% were classified as hospital-acquired (with symptom onset 8 or more days after admission and before discharge). We estimated that only 30% (range across weeks and 200 simulations: 20-41%) of symptomatic hospital-acquired infections would be identified. Misclassified cases and onward transmission from missed infections could account for 15% (mean, 95% range over 200 simulations: 14.1%-15.8%) of cases currently classified as community-acquired COVID-19. From this, we estimated that 26,600 (25,900 to 27,700) individuals acquired a symptomatic SARS-CoV-2 infection in an acute Trust in England before 31st July 2020, resulting in 15,900 (15,200-16,400) or 20.1% (19.2%-20.7%) of all identified hospitalised COVID-19 cases. Conclusion Transmission of SARS-CoV-2 to hospitalised patients likely caused approximately a fifth of identified cases of hospitalised COVID-19 in the "first wave", but fewer than 1% of all SARS-CoV-2 infections in England. Using symptom onset as a detection method for hospital-acquired SARS-CoV-2 likely misses a substantial proportion (>60%) of hospital-acquired infections.