Nosocomial Respiratory Infections in a Rural Zambian Hospital

Abstract

The burden of nosocomial respiratory infections in rural southern Africa is poorly understood. We established a surveillance program at a rural Zambian hospital to detect influenza-like illness (ILI) and respiratory infections among hospitalized patients and a cohort of healthcare workers (HCWs). Nasopharyngeal specimens from symptomatic patients and HCWs underwent broadly multiplexed molecular testing to detect viruses and atypical bacteria. During 1 year of surveillance, 15 patients (1.7% of admissions) developed ILI more than 48 hours after admission. Among 44 HCWs, 19 (43%) experienced at least one ILI episode, with a total of 31 ILI episodes detected. Respiratory viruses were detected in 45% of patient and 55% of HCW specimens. The cumulative incidence of influenza infection among HCWs over 1 year was 9%. Overall, respiratory viruses were commonly found among patients and HCWs in a rural Zambian hospital with limited infection control infrastructure.

Figure 1.

Respiratory pathogens among healthcare workers and hospitalized patients. Percentages refer to proportion of total samples within each study population. Assays included antigenic targets for the following pathogens: adenovirus, coronavirus (non–SARS-CoV-2 species: HKU1, 229E, OC43, and NL63 subtypes), human metapneumovirus, rhinovirus/enterovirus, influenza A virus, influenza B virus, parainfluenza virus, respiratory syncytial virus, Bordetella pertussis, Chlamydia pneumoniae, and Mycoplasma pneumoniae.