Prevalence, incidence burden, and clinical impact of healthcare-associated infections and antimicrobial resistance: a national prevalent cohort study in acute care hospitals in Greece

Abstract

BackgroundAssessing the overall burden of healthcare-associated infections (HAIs) is challenging, but imperative in evaluating the cost-effectiveness of infection control programs. This study aimed to estimate the point prevalence and annual incidence of HAIs in Greece and assess the excess length of stay (LOS) and mortality attributable to HAIs, overall and for main infection sites and tracer antimicrobial resistance (AMR) phenotypes and pathogens.Patients and methodsThis prevalent cohort study used a nationally representative cross-section of 8,247 inpatients in 37 acute care hospitals to record active HAIs of all types at baseline and overall LOS and in-hospital mortality up to 90 days following hospital admission. HAI incidence was estimated using prevalence-to-incidence conversion methods. Excess mortality and LOS were assessed by Cox regression and multistate models correcting for confounding and time-dependent biases.ResultsHAIs were encountered with daily prevalence of 9.1% (95% confidence interval [CI] 7.8%–10.6%). The estimated annual HAI incidence was 5.2% (95% CI 4.4%–5.3%), corresponding to approximately 121,000 (95% CI 103,500–123,700) affected patients each year in the country. Ninety-day mortality risk was increased by 80% in patients with HAI compared to those without HAI (adjusted hazard ratio 1.8; 95% CI 1.3–2.6). Lower respiratory tract infections, bloodstream infections, and multiple concurrent HAIs doubled the risk of death, whereas surgical site and urinary tract infections were not associated with increased mortality. AMR had significant impact on the daily risk of 90-day mortality, which was increased by 90%–110% in patients infected by carbapenem-resistant gram-negative pathogens. HAIs increased LOS for an average of 4.3 (95% CI 2.4–6.2) additional days. Mean excess LOS exceeded 20 days in infections caused by major carbapenem-resistant gram-negative pathogens.ConclusionHAIs, alongside with increasing AMR, pose significant burden to the hospital system. Burden estimates obtained in this study will be valuable in future evaluations of infection prevention programs.

Health care-associated infections – an overview

“…The frequent types of HCAIs were lower respiratory tract infections (LRTIs), bloodstream infections, UTIs, SSIs, and systemic infections. 38 One systematic review and meta-analysis regarding HCAIs in Southeast Asian countries (Brunei, Myanmar, Cambodia, East Timor, Indonesia, Laos, Malaysia, the Philippines, Singapore, Thailand, and Vietnam) found an overall prevalence rate of 9.1% with the most common microorganisms being P. aeruginosa, the Klebsiella species, and Acinetobacter baumannii. 39 A study conducted in eight university hospitals of Iran (ranging from 60 to 700 beds) reported an overall HCAI frequency of 9.4%, the most common HCAIs were bloodstream infections, SSIs, UTIs, and pneumonia.…”

Antimicrobial Nanostructured Coatings: A Gas Phase Deposition and Magnetron Sputtering Perspective

“…More recently, the effort of the scientific community in developing NMs-based antimicrobial agents has been stimulated by the emergence of multi-drug-resistant pathogens, posing a world-wide challenge with a large socio-economic impact [28,29]. In particular, a major issue is due to microbe spreading by (1) cross-contamination through infected surfaces in nosocomial environments [30,31] (2) biofilm formation on the surfaces of medical implants, such as dental or bone repair devices [32][33][34][35][36]. Infectious diseases caused by fungi, viruses, bacteria, and particularly by multidrug resistant bacteria has an estimated annual cost (direct and indirect) ranging from 6 to 60 billion US$ [37] in the US only.…”

Epidemiological and clinical characteristics of healthcare-associated infection in elderly patients in a large Chinese tertiary hospital: a 3-year surveillance study

“…These infections occur during healthcare delivery for other diseases and even after discharge. HAIs are associated with prolonged hospital stay, poor prognosis, and increased mortality and economic burden [2][3][4]. A systematic review and meta-analysis reported that the major risk factors independently associated with HAIs were diabetes mellitus, immunosuppression, body temperature, surgery time in minutes, reoperation, cephalosporin exposure, days of exposure to central venous catheter, intensive care unit (ICU) admission, ICU stay in days, and mechanical ventilation [5].…”