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. 2022 Nov:129:82-88.
doi: 10.1016/j.jhin.2022.08.004. Epub 2022 Aug 20.

Burden of hospital-acquired SARS-CoV-2 infections in Germany: occurrence and outcomes of different variants

M Bonsignore  1 , S Hohenstein  2 , C Kodde  3 , J Leiner  2 , K Schwegmann  4 , A Bollmann  2 , R Möller  5 , R Kuhlen  5 , I Nachtigall  6
Affiliations

Burden of hospital-acquired SARS-CoV-2 infections in Germany: occurrence and outcomes of different variants

M Bonsignore et al. J Hosp Infect. 2022 Nov.

Abstract

Background: Avoiding in-hospital transmissions has been crucial in the COVID-19 pandemic. Little is known on the extent to which hospital-acquired SARS-CoV-2 variants have caused infections in Germany.

Aim: To analyse the occurrence and the outcomes of HAI with regard to different SARS-CoV-2 variants.

Methods: Patients with SARS-CoV-2 infections hospitalized between March 1st, 2020 and May 17th, 2022 in 79 hospitals of the Helios Group were included. Information on patients' characteristics and outcomes were retrieved from claims data. In accordance with the Robert Koch Institute, infections were classified as hospital-acquired when tested positive >6 days after admission and if no information hinted at a different source.

Findings: In all, 62,875 SARS-CoV-2 patients were analysed, of whom 10.6% had HAI. HAIs represented 14.7% of SARS-CoV-2 inpatients during the Wildtype period, 3.5% during Alpha (odds ratio: 0.21; 95% confidence interval: 0.19-0.24), 8.8% during Delta (2.70; 2.35-3.09) and 10.1% during Omicron (1.10; 1.03-1.19). When age and comorbidities were accounted for, HAI had lower odds for death than community-acquired infections (0.802; 0.740-0.866). Compared to the Wildtype period, HAIs during Omicron were associated with lower odds for ICU (0.78; 0.69-0.88), ventilation (0.47; 0.39-0.56), and death (0.33; 0.28-0.40).

Conclusion: Hospital-acquired SARS-CoV-2 infections occurred throughout the pandemic, affecting highly vulnerable patients. Although transmissibility increased with newer variants, the proportion of HAIs decreased, indicating improved infection prevention and/or the effect of immunization. Furthermore, the Omicron period was associated with improved outcomes. However, the burden of hospital-acquired SARS-CoV-2 infections remains high.

Keywords: COVID-19; Hospital-acquired infection; SARI; SARS-CoV-2; Variants.

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Figures

Figure 1
Figure 1
(A) Weekly incidences of community-acquired (black line) and hospital-acquired (grey line) infections. (B) Proportion of hospital-acquired infections to all hospitalized patients with SARS-CoV2. The smooth curves were generated via LOESS (locally weighted scatterplot smoothing).
See this image and copyright information in PMC

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Supplementary concepts