Comparison of Length of Hospital Stay for Community-Acquired Infections Due to Enteric Pathogens, Influenza Viruses and Multidrug-Resistant Bacteria: A Cross-Sectional Study in Hungary

Abstract

Community-acquired infections (CAI) can affect the duration of care and mortality of patients. Therefore, we aimed to investigate these as well as factors influencing the length of hospital stay in patients with CAI due to enteric pathogens, influenza viruses and multidrug-resistant (MDR) bacteria. We obtained data on 531 patients with CAI from the medical databases of a Hungarian university hospital and analyzed their characteristics using a regression model. Patients with MDR bacterial infection had the highest mortality (26.24%) and they stayed significantly longer in the hospital than cases with other CAIs. Our results showed that infection by Clostridioides difficile (odds ratio (OR): 6.98, 95% confidence interval (CI): 1.03-47.48; p = 0.047), MDR Escherichia coli (OR: 7.64, 95% CI: 1.24-47.17; p = 0.029), MDR Klebsiella spp. (OR: 7.35, 95% CI: 1.15-47.07; p = 0.035) and hospitalization in the department of pulmonology (OR: 5.48, 95% CI: 1.38-21.76; p = 0.016) and surgery (OR: 4.19, 95% CI: 1.18-14.81; p = 0.026) significantly increased, whereas female sex (OR: 0.62, 95% CI: 0.40-0.97; p = 0.037) and hospitalization in the department of pediatrics (OR: 0.17, 95% CI: 0.04-0.64; p = 0.009) decreased the odds of staying in the hospital for more than 6 days. Our findings provide new information on the epidemiology of CAI and can contribute to the development of public health programs that decrease the burden of infections acquired in the community.

Keywords: Hungary; community-acquired infections; enteric pathogen; gastroenteritis; influenza; length of hospital stay; mortality; multidrug-resistant bacteria; respiratory infections.

Figure 1

Flowchart of database development. ^a Patients with CAI caused by Adenovirus, Hepatitis viruses, Herpes viruses, Respiratory syncitial virus, Legionella pneumophila, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, Mycobacterium tuberculosis, Yersinia enterocolitica, Shigella sonnei, Enteropathogen Escherichia coli, Clostridium perfringens, Entamoeba hystolitica, Giardia lamblia and HIV virus. ^b Patients with CAI caused by Campylobacter jejuni ¹, Campylobacter coli ¹, Rotavirus ¹, Salmonella sp. ¹, Clostridioides difficile ¹, Influenza A and B viruses ², Methicillin-resistant Staphylococcus aureus ³, Vancomycin-resistant Enterococcus spp. ³, Multidrug-resistant (MDR) Acinetobacter baumannii ³, MDR Escherichia coli ³, MDR Enterobacter spp. ³, MDR Klebsiella spp. ³, MDR Pseudomonas aeruginosa ³, MDR Proteus mirabilis ³, MDR Citrobacter freundii ³, MDR Morganella morganii ³ and MDR Stenotrophomonas maltophilia ³.

Figure 2

Distribution of length of hospital stay of patients with community-acquired gastroenteritis, influenza and multidrug-resistant infections detected at the University of Debrecen Clinical Centre Nagyerdei Campus in 2020. Median, interquartile ranges and 1.5 times of interquartile ranges as whiskers are shown. Open circles and asterisks indicate outlier values. * p < 0.05, *** p < 0.001. Gastroenteritis includes patients with community-acquired Clostridioides difficile, Campylobacter sp., Salmonella sp. and Rotavirus infections. Influenza includes patients with community-acquired Influenza A and B viruses infections. MDR bacteria includes patients with community-acquired Methicillin-resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus spp., Multidrug-resistant (MDR) Acinetobacter baumannii, MDR Escherichia coli, MDR Enterobacter spp., MDR Klebsiella spp., MDR Pseudomonas aeruginosa, MDR Proteus mirabilis, MDR Citrobacter freundii, MDR Morganella morganii and MDR Stenotrophomonas maltophilia infections.

Figure 3

Number of days of care of patients with community-acquired infections detected at the University of Debrecen Clinical Centre Nagyerdei Campus in 2020 by the type of infectious disease. Median, interquartile ranges and 1.5 times of interquartile ranges as whiskers are shown. Asterisks indicate outlier values. Abbreviations: CDI: Clostridioides difficile, MRSA: Methicillin-resistant Staphylococcus aureus, MECO: Multidrug-resistant Escherichia coli, MKLE: Multidrug-resistant Klebsiella spp., MPAE: Multidrug-resistant Pseudomonas aeruginosa, MACI: Multidrug-resistant Acinetobacter baumannii, MENB: Multidrug-resistant Enterobacter spp., MSTM: Multidrug-resistant Stenotrophomonas maltophilia, MR OTHER: Other Multidrug-resistant organisms (Proteus mirabilis, Citrobacter freundii, Morganella morganii), VRE: Vancomycin-resistant Enterococcus spp.

Figure 4

Distribution of patients with community-acquired infections detected at the University of Debrecen Clinical Centre Nagyerdei Campus by the median number of days of care in 2020. Patients with community-acquired infections were divided into two groups based on the median number of days of care (≤6 days versus >6 days of hospitalisation). Abbreviations: CDI: Clostridioides difficile, MRSA: Methicillin-resistant Staphylococcus aureus, MECO: Multidrug-resistant Escherichia coli, MKLE: Multidrug-resistant Klebsiella spp., MPAE: Multidrug-resistant Pseudomonas aeruginosa, MACI: Multidrug-resistant Acinetobacter baumannii, MENB: Multidrug-resistant Enterobacter spp., MSTM: Multidrug-resistant Stenotrophomonas maltophilia, MR OTHER: Other Multidrug-resistant organisms (Proteus mirabilis, Citrobacter freundii, Morganella morganii), VRE: Vancomycin-resistant Enterococcus spp. ** p < 0.01, *** p < 0.001.

Figure 5

Distribution of patients with community-acquired infections detected at the University of Debrecen Clinical Centre Nagyerdei Campus in 2020 by place of residence. Place of residence was categorised as village, city and cities with county status (see the details on settlement categories in Section 2.2). Abbreviations: CDI: Clostridioides difficile, MRSA: Methicillin-resistant Staphylococcus aureus, MECO: Multidrug-resistant Escherichia coli, MKLE: Multidrug-resistant Klebsiella spp., MPAE: Multidrug-resistant Pseudomonas aeruginosa, MACI: Multidrug-resistant Acinetobacter baumannii, MENB: Multidrug-resistant Enterobacter spp., MSTM: Multidrug-resistant Stenotrophomonas maltophilia, MR OTHER: Other Multidrug-resistant organisms (Proteus mirabilis, Citrobacter freundii, Morganella morganii), VRE: Vancomycin-resistant Enterococcus spp. * p < 0.05, ** p < 0.01, *** p < 0.001.