Risk Factors on Healthcare-Associated Infections Among Hospitalized Tuberculosis Patients in China From 2001- 2020: A Systematic Review and Meta-Analysis

Abstract Background As a chronic communicable disease, tuberculosis (TB) is acknowledged as a global public health issue. A comprehensive analysis of risk factors on HAIs among TB hospitalized patients in Chinese hospitals is vacant. The aim of this systematic review and meta-analysis is to investigate the risk factors associated with healthcare-associated TB in Chinese hospitals. Methods Medline, EMBASE and Chinese Journals Online databases were searched. The search was limited to studies published from January 1st 2001 and December 31st 2020. Meta-analyses of ORs in the prevalence were estimated. Heterogeneity between studies was assessed based on the 𝝉 2 and I 2 statistics to select the meta-analysis model. Review Manager 5.3 was employed and P <0.05 was considered as the statistical significance. Results The databases searched 418 records, of which 11 published articles were included in the quantitative meta-analysis. A total of 11,922 TB hospitalized patients were included in the systematic review and meta-analysis, of which 1,133 were diagnosed as having HAIs. Older than 65 years (OR: 2.89[2.01-4.15]), presence of complication (OR: 3.28[2.10-5.13]), presence of diabetes mellitus (OR: 1.63[1.22-2.19]), invasive procedure (OR: 3.80[2.25-6.42]), longer than 15 days of hospitalization stay (OR: 2.09[1.64-2.64]), secondary tuberculosis (OR: 2.25[1.48-3.42]), smoking (OR: 1.40[1.02-1.93]), presence of underlying disease (OR: 2.66[1.53-4.62]), and use of antibiotics (OR: 2.77[2.35-3.27])were the main risk factors associated with higher HAIs prevalence among TB hospitalized patients with a statistical significance ( P <0.05). Conclusions older than 65 years, presence of complication, presence of diabetes mellitus, invasive procedure, longer than 15 days of hospitalization stay, secondary tuberculosis, smoking, presence of underlying disease, and use of antibiotics were the main risk factors which had a negative impact on HAIs among TB hospitalized patients in Chinese hospitals. These findings provided evidence for the policy makers and hospital managers to make effective infection prevention and control measures to constrain the rising of HAIs. It is also required that more cost-effective infection prevention and control measures should be widely applied in routinely medical treatment and clinical management to healthcare-associated TB.