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

Qi Zhou; Yelei Gao; Xingmei Wang; Rui Liu; Peipei Du; Xiaoqing Wang; Xianzhuo Zhang; Shuya Lu; Zijun Wang; Qianling Shi; Weiguo Li; Yanfang Ma; Xufei Luo; Toshio Fukuoka; Hyeong Sik Ahn; Myeong Soo Lee; Enmei Liu; Yaolong Chen; Zhengxiu Luo; Kehu Yang; COVID-19 Evidence and Recommendations Working Group

doi:10.21037/atm-20-3324

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

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

Authors

Qi Zhou^{1

2}, Yelei Gao^{3

4

5}, Xingmei Wang^{3

4

5}, Rui Liu^{3

4

5}, Peipei Du⁶, Xiaoqing Wang^{3

4

5}, Xianzhuo Zhang^{1

2}, Shuya Lu^{2

7

8}, Zijun Wang², Qianling Shi^{1

2}, Weiguo Li^{3

4

5}, Yanfang Ma², Xufei Luo⁹, 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

¹ The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China.
² Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.
³ Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
⁴ National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
⁵ Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
⁶ School of Public Health, Chengdu Medical College, Chengdu 610500, China.
⁷ Department of Pediatric, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
⁸ Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China.
⁹ School of Public Health, Lanzhou University, Lanzhou 730000, China.
¹⁰ Emergency and Critical Care Center, the Department of General Medicine, Department of Research and Medical Education at Kurashiki Central Hospital, Kurashiki, Japan.
¹¹ Advisory Committee in Cochrane Japan, Tokyo, Japan.
¹² Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
¹³ Korea Cochrane Centre, Seoul, Korea.
¹⁴ Korea Institute of Oriental Medicine, Daejeon, Korea.
¹⁵ University of Science and Technology, Daejeon, Korea.
¹⁶ Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou 730000, China.
¹⁷ Chinese GRADE Center, Lanzhou 730000, China.
¹⁸ Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China.

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.