Gender, Department Linked With Length of Hospital Stay for Patients With Community-Acquired Infections

Certain factors may influence length of hospital stay among patients with community-acquired infections (CAIs), according to study findings published in International Journal of Environmental Research and Public Health.

Defined as infections that are clinically evident at the time of hospital admission or that are diagnosed within 48 hours of admission without any previous encounter with health care, CAIs remain a major challenge for health care systems despite therapeutic advancements that have reduced risks of morbidity and mortality.

Gastroenteritis, respiratory infections, and diseases caused by multidrug-resistant (MDR) bacteria are the most frequently detected CAIs, noted the present study's researchers, which contribute to increased disability-adjusted life-years and health care resource utilization. Clostridioides difficile infection (CDI), a frequent cause of gastroenteritis and the most common health care–associated infection in US adults, has also been shown to occur due to infection acquired in the community, with 20% to 45% of all CDI cases attributed as CAI.

“As CAIs caused by enteric pathogens, influenza viruses, and MDR bacteria have become more common, the number of complications and deaths related to them has also increased,” said the study authors. “To prevent CAI-associated morbidity and mortality, information is needed on the characteristics of patients hospitalized with these diseases and factors affecting their condition.”

They conducted a cross-sectional analysis of hospitalized patients with CAI caused by enteric pathogens, influenza viruses, and MDR bacteria from the medical databases of the University of Debrecen Clinical Centre Nagyerdei Campus, Hungary, from January 1 to December 31, 2020, to investigate whether there is a difference in hospital stay and mortality risk among types of CAIs.

Additional analyses were performed to identify factors that may influence the length of hospital stay of patients with those diseases, and these factors were age, sex, place of residence, time of admission and discharge, hospital ward (place of treatment), time of sampling, test material, microbiological result, and previous antibiotic use.

Data on 531 patients with CAI (mean [SD] age, 46.68 [34.48] years; 51.79%, female patients) were collected for the analysis, in which most patients with CAI were aged 0 to 9 years (32.96%, n = 175), followed by 70 to 79 (16.76%, n = 89), 80 to 89 (16.57%, n = 88), and 60 to 69 (14.31%, n = 76) years.

Findings showed that patients with MDR bacterial infection had the highest mortality (26.24%) and they stayed significantly longer in the hospital than cases with other CAIs. Several types of CAIs and certain variables were additionally associated with significantly increased odds of staying in the hospital for more than 6 days:

• CDI (OR, 6.98; 95% CI, 1.03-47.48; P = .047)
• MDR Escherichia coli (OR, 7.64; 95% CI, 1.24-47.17; P = .029),
• MDR Klebsiella spp (OR, 7.35; 95% CI, 1.15-47.07; P = .035)
• Hospitalization in the Department of Pulmonology (OR, 5.48; 95% CI, 1.38-21.76; P = .016)
• Hospitalization in the Department of Surgery (OR, 4.19; 95% CI, 1.18-14.81; P = .026)
  

Conversely, female sex (OR, 0.62; 95% CI, 0.40-0.97; P = .037) and hospitalization in the Department of Pediatrics (OR, 0.17; 95% CI, 0.04-0.64; P = .009) was associated with decreased odds of staying in the hospital for more than 6 days.

As results are based on data from patients with CAI from only 1 hospital in Hungary, the findings may not be generalizable to patients treated in other hospitals.

“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,” concluded the researchers. “Further studies are needed to characterize cases with CAI, especially those caused by MDR bacteria, to understand which factors increase the length of hospital stay and risk of death in patients.”

Reference

Orosz N, Tóth TT, Gyuró GV, et al. 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. Int J Environ Res Public Health. 2022;19(23):15935. doi:10.3390/ijerph192315935