A nationwide assessment of the burden of healthcare-associated infections and antimicrobial use among surgical patients: results from Serbian point prevalence survey, 2017

Abstract

Background As the only non-European Union (EU) country, Serbia participated in a second point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use (AMU) organized by the European Centre for Disease Prevention and Control (ECDC) in the EU countries. Here, we aimed to estimate the prevalence of HAI and AMU in patients who had recently undergone a surgery and to compare risk profile, HAI rates, and AMU among surgical patients and non-surgical patients. Methods A national PPS was performed in 65 Serbian acute-care hospitals, in November 2017. In this paper, the data of 61 hospitals for adult acute-care were analyzed. To ensure the comparability of study design we used the Serbian translation of ECDC case definitions and ECDC PPS protocol. The trained infection control staff, led by a hospital coordinator, reviewed medical records to identify HAI active at the time of the survey and AMU. Only inpatients admitted to the ward before 8 a.m. on the day if the survey were included. Results A total of 12,478 patients from 61 hospitals for adult acute-care were eligible for inclusion in this study. Significantly higher proportions of surgical patients were female, belonged to the 60-to-79 age group, and were less severely ill. Also, extrinsic factors (invasive devices, hospitalization at the ICU, and prior antibiotics therapy) were more frequent in surgical patients. Prevalence of HAIs was higher among surgical patients (261/3626; 7.2%) than among non-surgical patients (258/8852; 2.9%) (p < 0.0001). The highest prevalence of all HAIs was noted in patients who had kidney transplantation (4/11; 36.4%), while SSIs were the most prevalent among patients who had peripheral vascular bypass surgery (3/15; 20.0%). Non-surgical patients received treatment for community-acquired infections in significantly higher proportion (2664/8852; 64.3) (p < 0.001). Surgical prophylaxis for more than 1 day was applied in 71.4% of surgical patients. Conclusion We have provided an insight into the burden of HAIs and AMU among Serbia acute-care hospitals, and highlighted several priority areas and targets for quality improvement.

The Impact of COVID-19 on the Profile of Hospital-Acquired Infections in Adult Intensive Care Units

“…In Serbia, AMR for HAIs has been evaluated through national point prevalence surveys and isolated reports from various hospitals [17][18][19], but no studies detailing the profile of HAIs and AMR have been published since the beginning of the pandemic in our country. In our previous two-year study conducted before the pandemic [20], we identified risk factors for both acquisition and mortality in patients with HAIs in adult ICUs and discovered high resistance rates to most tested antibiotics.…”

Impact of the European Union on access to medicines in low- and middle-income countries: A scoping review

“…A causal link between EMA's and LMICs’ decisions were not evaluated. Other LMIC authorities have adopted the definitions, methods, and tools from the European Centre for Disease Prevention and Control or Eurobarometer to monitor local antibiotic use and generate cross-national comparisons [ 52 , 53 ]. National health ministries adapted these EU tools to generate data supporting the implementation of Serbia's national antibiotic guidelines and informing Thailand's public communication and strategy on antimicrobial resistance [ 52 , 53 ].…”

Microbiology of Healthcare-Associated Infections: Results of a Fourth National Point Prevalence Survey in Serbia

“…These hospitals are now responsible for submitting annual reports to the public health institutions that curate the data from around the country, forming a coherent system of national surveillance. Second, the results generated from these surveys led to the development of national guidelines for certain types of HAIs such as SSIs [ 14 ], but also procedures for hand hygiene, C. difficile infections and other infection control measures. Third, extensive education of healthcare staff through a range of workshops and training has led to an overall increase in awareness and importance of proper HAI monitoring and reporting.…”

“…Though our findings differ from European reports that show respiratory tract infections as the leading HAI type, countries have reported varying results, including Switzerland, where SSIs comprised 30% of all HAIs, whereas data from Ukraine showed almost 60% of all HAIs to be SSIs [ 19 ]. In our setting, UTIs have been readily identified as the most common HAI type in two previous national PPS [ 14 , 15 ]. There is an urgent need to enhance preventive measures for these infections in our hospitals, especially the catheter-associated urinary tract infections, in accordance with current guidelines [ 20 ].…”

“…A cross-sectional point-prevalence study encompassing 65 Serbian hospitals (63 public, 2 private) was carried out in November 2017. The method of the study is presented in more detail in our previously published article [ 14 ] related to surgical patients. It was a sub-study within the national PPS designed and embedded to compare the characteristics of operated and non-operated patients, as well as to analyze the use of antibiotics in these two groups of patients.…”