Three-Year Trends of Healthcare-Associated Infections and Antibiotic Use in Acute Care Hospitals: Findings from 2016–2018 Point Prevalence Surveys in Sicily, Italy

Abstract

Repeated point prevalence surveys (PPSs) of healthcare-associated infections (HAIs) and antibiotic use are crucial to monitor trends over years at regional level, especially in countries with decentralized healthcare systems. Here, we reported the results of three PPSs conducted in Sicilian acute care hospitals (Italy) from 2016 to 2018, according to the European Centre for Disease Prevention and Control protocol. Overall, prevalence of patients with at least one HAI was 5.1% in 2016, 4.7% in 2017, and 5.1% in 2018, without a significant trend over years (p = 0.434). At the patient level, the most important factor associated with HAIs was antibiotic use, since patients receiving at least one antimicrobial were more likely to be infected than those who did not receive antimicrobials (OR = 18.87; 95%CI = 13.08–27.22). The analysis of the prevalence of antibiotic use indicated a significant trend across years of the PPSs: 50.5% of patients received at least one antimicrobial agent in 2016, 55.2% in 2017, and 53.7% in 2018 (p < 0.001). The most common indication for antimicrobial prescription was medical prophylaxis, while third-generation cephalosporins represented the most frequently used class of antimicrobial agents, followed by fluoroquinolones and combinations of penicillins. Our study confirms that HAIs still remain a major public health issue, which could be intensified by antibiotic abuse. This raises the need for infection prevention and control and antibiotic stewardship programs aimed to improve knowledge about appropriate antibiotic prescription and to reduce the use of broad-spectrum antimicrobials.

Burden of Healthcare-Associated Infections in Sicily, Italy: Estimates from the Regional Point Prevalence Surveys 2016–2018

“…In the European and in the Italian PPSs, representative samples of hospitals were selected using a systematic sampling design. Conversely, in the three Sicilian PPSs all acute care hospitals were invited to participate in the framework of a regional action plan for the prevention of HAIs, AMR, and inappropriate use of antimicrobials [ 7 ]. We also recognize that some of these differences were probably due to the fact that in our study we limited the analysis to four selected HAIs (i.e., HAP, HA BSI, SSI, and HA UTI) and to patients aged 45 years or older.…”

“…For the current study, we used data from three consecutive regional PPSs of HAIs and antimicrobial use in acute care hospitals from Sicily: the first Sicilian PPS was launched in 2016 and was followed by two further surveys in 2017 and 2018 [ 7 ]. Each survey was in accordance with the European PPS, adopting procedures and definitions from the 5.1 version of the ECDC protocol [ 14 ].…”

“…When a patient showed evidence of being affected by an HAI, further data were collected about the type of HAI and the date of onset. All the analyses were based on anonymous information collected during the regional PPSs of HAIs in acute care hospitals implemented by the Sicilian Health Authority in the framework of a regional action plan for the prevention of HAIs, AMR, and inappropriate use of antimicrobials and hence the study did not require informed consent from participants [ 7 ].…”

“…As a part of the European PPS, it was also estimated that nearly 8% of patients in Italian acute care hospitals had at least one HAI on the day of the survey [ 6 ]. At a regional level, instead, a recent analysis of the three repeated PPSs conducted in Sicily, Italy from 2016 to 2018 estimated approximately 5% prevalence of HAIs, without a significant trend from year to year [ 7 ]. By contrast, the same study showed an increasing trend in the use of antibiotics from 2016 to 2018 [ 7 ].…”

“…At a regional level, instead, a recent analysis of the three repeated PPSs conducted in Sicily, Italy from 2016 to 2018 estimated approximately 5% prevalence of HAIs, without a significant trend from year to year [ 7 ]. By contrast, the same study showed an increasing trend in the use of antibiotics from 2016 to 2018 [ 7 ].…”