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. 2020 May;8(10):629.
doi: 10.21037/atm-20-3324.

Nosocomial infections among patients with COVID-19, SARS and MERS: a rapid review and meta-analysis

Qi Zhou  1   2 , Yelei Gao  3   4   5 , Xingmei Wang  3   4   5 , Rui Liu  3   4   5 , Peipei Du  6 , Xiaoqing Wang  3   4   5 , Xianzhuo Zhang  1   2 , Shuya Lu  2   7   8 , Zijun Wang  2 , Qianling Shi  1   2 , Weiguo Li  3   4   5 , Yanfang Ma  2 , Xufei Luo  9 , Toshio Fukuoka  10   11 , Hyeong Sik Ahn  12   13 , Myeong Soo Lee  14   15 , Enmei Liu  3   4   5 , Yaolong Chen  2   16   17   18 , Zhengxiu Luo  3   4   5 , Kehu Yang  1   2   18 ; COVID-19 Evidence and Recommendations Working Group
Affiliations

Nosocomial infections among patients with COVID-19, SARS and MERS: a rapid review and meta-analysis

Qi Zhou et al. Ann Transl Med. 2020 May.

Abstract

Background: COVID-19, a disease caused by SARS-CoV-2 coronavirus, has now spread to most countries and regions of the world. As patients potentially infected by SARS-CoV-2 need to visit hospitals, the incidence of nosocomial infection can be expected to be high. Therefore, a comprehensive and objective understanding of nosocomial infection is needed to guide the prevention and control of the epidemic.

Methods: We searched major international and Chinese databases: Medicine, Web of Science, Embase, Cochrane, CBM (China Biology Medicine disc), CNKI (China National Knowledge Infrastructure) and Wanfang database for case series or case reports on nosocomial infections of COVID-19, SARS (severe acute respiratory syndromes) and MERS (Middle East respiratory syndrome) from their inception to March 31st, 2020. We conducted a meta-analysis of the proportion of nosocomial infection patients in the diagnosed patients, occupational distribution of nosocomial infection medical staff.

Results: We included 40 studies. Among the confirmed patients, the proportions of nosocomial infections with early outbreaks of COVID-19, SARS, and MERS were 44.0%, 36.0%, and 56.0%, respectively. Of the confirmed patients, the medical staff and other hospital-acquired infections accounted for 33.0% and 2.0% of COVID-19 cases, 37.0% and 24.0% of SARS cases, and 19.0% and 36.0% of MERS cases, respectively. Nurses and doctors were the most affected among the infected medical staff. The mean numbers of secondary cases caused by one index patient were 29.3 and 6.3 for SARS and MERS, respectively.

Conclusions: The proportion of nosocomial infection in patients with COVID-19 was 44% in the early outbreak. Patients attending hospitals should take personal protection. Medical staff should be awareness of the disease to protect themselves and the patients.

Keywords: COVID-19; meta-analysis; nosocomial infection; rapid review.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-3324). MSL serves as the unpaid editorial board member of Annals of Translational Medicine from Nov 2019 to Oct 2021. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of the literature search.
Figure 2
Figure 2
The proportion of nosocomial infections among confirm cases of COVID-19, SARS and MERS.
Figure 3
Figure 3
Proportions of health care workers among confirmed cases of COVID-19, SARS and MERS.
Figure 4
Figure 4
Proportions of nosocomial infections excluding health care workers among confirm cases of COVID-19, SARS and MERS.
Figure 5
Figure 5
Proportion of doctors among hospital staff with COVID-19, SARS and MERS.
Figure 6
Figure 6
Proportion of nurses among hospital staff with COVID-19, SARS and MERS.
Figure 7
Figure 7
Proportion of staff other than doctors or nurses among hospital staff with COVID-19, SARS and MERS.
Figure 8
Figure 8
Proportion of health care staff with SARS who did not take protective measures.
See this image and copyright information in PMC

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