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

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.

A comprehensive study on the factors influencing the generation of infectious healthcare waste in inpatient healthcare institutions in Hungary

Infectious healthcare waste (IHCW) poses a significant biohazard and public health risk. This study examines IHCW formation and influencing factors in Hungarian inpatient healthcare institutions. Factors such as hospital type, regional location, indicators related to patient traffic, educational activity, patients of certain types of medical specialties, and healthcare-associated infections (HAIs) were examined. Univariate and multivariate statistical methods identified significant predictors of IHCW occurrence. The generation rate of IHCW ranged from 0.15 to 0.81 kg/bed/day nationally, and it increased by 40.74% between 2017 and 2021, significantly impacted by the COVID-19 pandemic. The data also showed that as the number of beds increased, the IHCW production rate increased proportionally. The results indicate that IHCW generation rates vary significantly by hospital type, with university hospitals producing the most waste. The incidence of HAI multidrug-resistant (MDR) bacterial infections emerged as the primary driver of IHCW generation, along with educational activity, the number of intensive care unit patients, and regional differences. The Southern Great Plain region had the highest IHCW production (0,42 kg/bed/day) among the seven regions studied. The study highlights the critical impact of HAI MDR infections on IHCW production, emphasizing the need for targeted waste management in high-risk areas. Regional differences indicate the necessity for tailored strategies to address local waste management challenges. This study provides essential insights into IHCW formation and influencing factors in Hungary, offering valuable information for policy and practice.Implications: Nowadays, one of the main problems related to waste management is the uncontrollable amount of waste generated in the healthcare sector. Infectious healthcare waste (IHCW) represents a significant biological hazard and a high public health risk, both on an individual and a community level, so a more precise knowledge of these risks is extremely important. In the Central European region, very few studies have dealt with the infectious waste generated in the healthcare sector, and this is the first such research in Hungary. The primary aim of this study is to measure the amount of IHCW produced in various regions and hospital types in Hungary, and to examine the general and specific factors that affect the generation rate of this waste. The findings reveal that IHCW generation rates (GR) vary considerably across different hospital types and regions. This highlights the need for targeted waste management practices in individual institutions. In addition, the study emphasizes the importance of developing region-specific waste management strategies in view of regional inequalities. A crucial insight from the study is that the incidence of healthcare-associated infections (HAIs), particularly multidrug-resistant (MDR) bacterial infections, has the most significant impact on IHCW GR, surpassing other known factors. This suggests that effective control of HAIs, especially MDR bacterial infections, can lead to a substantial reduction in IHCW. The study also showed the impact of the COVID-19 pandemic not only on the production of IHCW, but also on individual influencing factors. Overall, the study provides valuable insights for informing policy and practice. By understanding the specific factors influencing IHCW production, policymakers and healthcare practitioners can develop more effective waste management policies and practices. This highlights the need for tailored waste management strategies that take into account the unique characteristics of each hospital type and geographic region, ultimately reducing the healthcare waste burden and providing a healthier and safer environment for all.

Hospital-based cross-sectional study on the clinical characteristics of children with severe acute respiratory infections in Hungary

BACKGROUND

Severe acute respiratory infection (SARI) is a major cause for hospital admission and associated with high mortality among children worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses and respiratory syncytial virus (RSV) are the most frequently identified pathogens in children with SARI. The duration of care can be affected by the type of infection and patient characteristics. Therefore, the objective of this study was to identify factors affecting the length of hospitalization in children infected with SARS-CoV-2, influenza A and RSV.

METHODS

We collected data on 713 children with SARI from the medical databases of a university hospital in Hungary. To examine whether there is a difference in the length of hospitalization in children with the SARI Kruskal-Wallis test was performed. To determine the factors that may have an impact on the duration of care a multiple logistic regression analysis was executed.

RESULTS

Our results showed that among RSV infected patients the proportions of children requiring intensive care (8.94%), mechanical ventilation (8.94%) and oxygen therapy (13.01%) and suffering from pneumonia (29.27%) were larger than among cases with SARS-CoV-2 and influenza A infection. Considering the age distribution and the duration of care in children with SARI, cases with RSV were significantly younger (p < 0.001) and stayed longer in the hospital (median: 5 days, IQR: 4-7 days, p < 0.001) than those with SARS-CoV-2 and influenza A virus. Multiple logistic regression analysis showed that RSV infection (adjusted odds ratio (aOR): 3.25, 95% confidence interval (CI): 1.43-7.38; p = 0.005), pneumonia (aOR: 3.65, 95% CI: 2.14-6.24; p < 0.001), mechanical ventilation or oxygen therapy (aOR: 3.23, 95% CI: 1.29-8.11; p = 0.012) and underlying illnesses (aOR: 2.39, 95% CI: 1.35-4.23; p = 0.003) significantly increased the odds of hospitalization for more than 4 days.

CONCLUSIONS

Our research showed that of the viruses causing SARI, RSV had the greatest clinical relevance, contributing to hospital stays of more than 4 days in a large share of paediatric patients below 1 year of age. Our results supply new information on children with SARI, and provide evidence for health policy makers to allocate additional resources to hospitals during SARI epidemics.