Investigation of multiple nosocomial infections using a semi-Markov multi-state model
Xiao Zhong1, Dong-Li Wang2, Li-Hua Xiao3
1Infection Management Department, Shenzhen Guangming District People's Hospital, Shenzhen, Guangdong, 518106, China. 187197283@qq.com.
Background:
The prevalence of multiple nosocomial infections (MNIs) is on the rise, however, there remains a limited comprehension regarding the associated risk factors, cumulative risk, probability of occurrence, and impact on length of stay (LOS).
Method:
This multicenter study includes all hospitalized patients from 2020 to July 2023 in two sub-hospitals of a tertiary hospital in Guangming District, Shenzhen. The semi-Markov multi-state model (MSM) was utilized to analyze risk factors and cumulative risk of MNI, predict its occurrence probability, and calculate the extra LOS of nosocomial infection (NI).
Results:
The risk factors for MNI include age, community infection at admission, surgery, and combined use of antibiotics. However, the cumulative risk of MNI is lower than that of single nosocomial infection (SNI). MNI is most likely to occur within 14 days after admission. Additionally, SNI prolongs LOS by an average of 7.48 days (95% Confidence Interval, CI: 6.06-8.68 days), while MNI prolongs LOS by an average of 15.94 days (95% CI: 14.03-18.17 days). Furthermore, the more sites of infection there are, the longer the extra LOS will be.
Conclusion:
The longer LOS and increased treatment difficulty of MNI result in a heavier disease burden for patients, necessitating targeted prevention and control measures.
Insights
Multiple nosocomial infections (MNIs) increase patient disease burden. Identifying risk factors and understanding the prolonged length of stay (LOS) associated with MNIs is crucial for effective prevention strategies.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Health Services Research
Background:
- Rising prevalence of multiple nosocomial infections (MNIs).
- Limited understanding of MNI risk factors, cumulative risk, and impact on length of stay (LOS).
Purpose of the Study:
- Analyze risk factors and cumulative risk of MNI.
- Predict MNI occurrence probability.
- Quantify the extra LOS caused by nosocomial infections (NI).
Main Methods:
- Multicenter study of hospitalized patients (2020-2023).
- Utilized semi-Markov multi-state model (MSM).
- Analyzed risk factors, cumulative risk, occurrence probability, and extra LOS for MNI and single nosocomial infection (SNI).
Main Results:
- Key MNI risk factors identified: age, community infection, surgery, antibiotic use.
- Cumulative MNI risk is lower than SNI.
- MNI most likely occurs within 14 days of admission.
- SNI increases LOS by ~7.48 days; MNI increases LOS by ~15.94 days.
- Increased infection sites correlate with longer extra LOS.
Conclusions:
- MNI significantly increases patient disease burden due to longer LOS and treatment complexity.
- Highlights the need for targeted prevention and control measures for MNIs.
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