Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople)

B. Carter, J.T. Collins , F. Barlow-Pay, F. Rickard , E. Bruce, A. Verduri , T.J. Quinn, E. Mitchell, A. Price , A. Vilches-Moraga, M.J. Stechman, R. Short , A. Einarsson, P. Braude, S. Moug, P.K. Myint, J. Hewitt* (Corresponding Author), L. Pearce, K. McCarthy, the COPE Study Collaborators

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Introduction
Hospital admissions for non-COVID-19 pathology have significantly reduced. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality. There is an urgent need for clarity regarding patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection [NC]), their risk of mortality, compared to those with community acquired COVID-19 (CAC) infection.

Methods
The COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazards ratio [aHR]), and secondary outcomes were Day-7 mortality and the time-to-discharge. A mixed-effects multivariable Cox’s proportional hazards model was used, adjusted for demographics and comorbidities.

Results
Our study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to 28th April, 2020. 12.5% of COVID-19 infections were acquired in hospital. 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days, which compared to 10 days in CAC patients. In the primary analysis, NC infection was associated with reduced mortality (aHR=0.71, 95%CI 0.51-0.99). Secondary outcomes found no difference in Day-7 mortality (aOR=0.79, 95%CI 0.47-1.31), but NC patients required longer time in hospital during convalescence (aHR=0.49, 95%CI 0.37-0.66).

Conclusion
The minority of COVID-19 cases were the result of NC transmission. Whilst no COVID-19 infection comes without risk, patients with NC had a reduced risk of mortality compared to CAC infection, however, caution should be taken when interpreting this finding.

In the United Kingdom, authority to conduct the study was granted by the Health Research Authority (20/HRA/1898), and in Italy by the Ethics Committee of Policlinico Hospital Modena (Reference 369/2020/OSS/AOUMO). Cardiff University was the study sponsor.
Original languageEnglish
JournalJournal of Hospital Infection
Early online date21 Jul 2020
DOIs
Publication statusE-pub ahead of print - 21 Jul 2020

Keywords

  • COVID-19
  • Nosocomial infection
  • community acquired infection
  • nosocomial SARS-CoV-2
  • infection control
  • hospital-acquired infection
  • digestive disease

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    Carter, B., Collins , J. T., Barlow-Pay, F., Rickard , F., Bruce, E., Verduri , A., Quinn, T. J., Mitchell, E., Price , A., Vilches-Moraga, A., Stechman, M. J., Short , R., Einarsson, A., Braude, P., Moug, S., Myint, P. K., Hewitt, J., Pearce, L., McCarthy, K., & the COPE Study Collaborators (2020). Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople). Journal of Hospital Infection. https://doi.org/10.1016/j.jhin.2020.07.013