Investigation of multiple nosocomial infections using a semi-Markov multi-state model

Abstract

Abstract Background The prevalence of multiple nosocomial infections (MNIs) is on the rise, however, there remains a limited comprehension regarding the associated risk factors, cumulative risk, probability of occurrence, and impact on length of stay (LOS). Method This multicenter study includes all hospitalized patients from 2020 to July 2023 in two sub-hospitals of a tertiary hospital in Guangming District, Shenzhen. The semi-Markov multi-state model (MSM) was utilized to analyze risk factors and cumulative risk of MNI, predict its occurrence probability, and calculate the extra LOS of nosocomial infection (NI). Results The risk factors for MNI include age, community infection at admission, surgery, and combined use of antibiotics. However, the cumulative risk of MNI is lower than that of single nosocomial infection (SNI). MNI is most likely to occur within 14 days after admission. Additionally, SNI prolongs LOS by an average of 7.48 days (95% Confidence Interval, CI: 6.06–8.68 days), while MNI prolongs LOS by an average of 15.94 days (95% CI: 14.03–18.17 days). Furthermore, the more sites of infection there are, the longer the extra LOS will be. Conclusion The longer LOS and increased treatment difficulty of MNI result in a heavier disease burden for patients, necessitating targeted prevention and control measures.

Keywords

• Nosocomial infection
• Multiple nosocomial infection
• Semi-Markov multi-state model
• Cumulative risk
• Risk factors
• Length of stay