背景:尽管养老院中的老年人对传染病的易感性更大,传染病对其死亡率的影响程度尚不清楚。因此,我们量化了荷兰疗养院季节性传染病与全因死亡率之间的关联.
方法:我们分析了荷兰养老院每周传染病哨点监测的时间序列(2009年1月至2021年12月)。使用具有二项分布和身份联系的广义线性模型将全因死亡率与感染发生率相关联:COVID-19(2020-2021),胃肠炎(GE),流感样疾病(ILI),和下呼吸道感染(LRTIs)在0至4周的时间滞后(感染发生后0至4周的死亡率)。
结果:超过13年,参加了81个疗养院,每年有20至35套房屋(平均:26套)。在1,864,667个居住星期内,共有11,555人全因死亡,平均死亡率为6.2/1000个居民周。所有4种测试的传染病均与疗养院的全因死亡率显着相关(P≤0.01)。总的来说,这些感染性疾病与所有死亡的18.6%(95%CI,17.8%-19.3%)相关.在12个ILI季节中的7个中,死亡率与ILI之间的关联显着。与特定传染病相关的年死亡率如下:LRTI(10.2%;95%CI,9.6%-10.8%),ILI(8.2%;95%CI,7.5%-8.9%)(超过12个显著季节中的7个),COVID-19(6.5%;95%CI,5.4%-7.7%)(2019-2021年,因为以前没有SARS-CoV-2的流通),和GE(2.3%;95%CI,2.0%-2.5%)。
结论:在疗养院,季节性呼吸道和胃肠道感染的发生与近五分之一的全因死亡相关.虽然感染预防和监测可能已经在一些疗养院进行,实施至关重要,并加强有针对性的策略,如(手)卫生协议,环境清洁实践,减少液滴和气溶胶的传播,和疫苗接种,以有效解决特定感染。
BACKGROUND: Although older people in nursing homes have a larger susceptibility to infectious diseases, the extent to which infectious diseases contribute to their mortality is unknown. Therefore, we quantified the associations between seasonal infectious diseases and all-cause mortality in Dutch nursing homes.
METHODS: We analyzed time series (January 2009 to December 2021) of the weekly sentinel surveillance of infectious diseases in Dutch nursing homes. A generalized linear model with binomial distribution and identity link was used to associate the proportion of all-cause mortality with the incidence of infections: COVID-19 (2020-2021), gastroenteritis (GE), influenza-like illness (ILI), and lower respiratory tract infections (LRTIs) at 0- to 4-week time-lags (mortality incidence at 0 to 4 weeks after infections incidence).
RESULTS: Over 13 years, 81 nursing homes participated, with 20 to 35 homes each year (mean: 26). A total of 11,555 all-cause deaths occurred over 1,864,667 resident weeks, averaging a mortality incidence of 6.2 per 1000 resident weeks. All 4 tested infectious diseases exhibited a significant association with all-cause mortality in nursing homes (P ≤ .01). Collectively, these infectious diseases were associated with 18.6% (95% CI, 17.8%-19.3%) of all deaths. The association between mortality and ILI was significant in 7 of 12 ILI seasons. Yearly mortality associated with the specific infectious diseases was as follows: LRTI (10.2%; 95% CI, 9.6%-10.8%), ILI (8.2%; 95% CI, 7.5%-8.9%) (over the 7 of 12 significant seasons), COVID-19 (6.5%; 95% CI, 5.4%-7.7%) (over 2019-2021 as there was no previous SARS-CoV-2 circulation), and GE (2.3%; 95% CI, 2.0%-2.5%).
CONCLUSIONS: In nursing homes, the occurrence of seasonal respiratory and gastrointestinal infections is associated with nearly one-fifth of all-cause deaths. Although infection prevention and surveillance may already be performed in some nursing homes, it is vital to implement, and enhance targeted strategies like (hand) hygiene protocols, environmental cleaning practices, reducing droplet and aerosol transmission, and vaccination to effectively address specific infections.