A Point Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Public Acute Care Hospitals in Crete, Greece

Abstract

Background: Both healthcare-associated infections (HAIs) and antimicrobial resistance are associated with an increased length of stay and hospital costs, while they have also been linked to high morbidity and mortality rates. In 2016 and 2017, the latest point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals highlighted an HAI prevalence of 6.5%, while Greece had a higher HAI prevalence of 10%. The aim of this PPS was to record the prevalence of HAIs and antimicrobial use in all eight public acute care hospitals in Crete, Greece during the COVID-19 pandemic in order to highlight the types of infections and antimicrobial practices that need to be prioritized for infection control initiatives. Methods: The PPS was conducted between 30 March and 15 April 2022, according to the ECDC standardized relevant protocol (version 5.3). Statistics were extracted using the ECDC Helics.Win.Net application (software version 4.1.0). Results: A total of 1188 patients were included. The overall point prevalence of patients with at least one HAI was 10.6%. The most frequent types of infections were pneumonia (34.3%), bloodstream infections (10.5%), systemic infections and urinary tract infections (10.5% and 9.1%, respectively). In 14 (12.4%) cases, the pathogen responsible for HAI was SARS-CoV-2 following onsite spread, accounting for almost 10% of all HAIs. Microorganisms were identified in 60.1% of HAIs. Antimicrobials were administered in 711 (59.8%) patients, with 1.59 antimicrobials used per patient. Conclusion: The prevalence of HAI and antimicrobial use among hospitalized patients in Crete, Greece was similar to the national HAI prevalence in 2016 despite the enormous pressure on public hospitals due to the COVID-19 pandemic. Nevertheless, both HAI prevalence and antimicrobial use remain high, underlining the need to implement adequate infection control and antimicrobial stewardship interventions.

A Six-Year Retrospective Study of Microbiological Characteristics and Antimicrobial Resistance in Specimens from a Tertiary Hospital’s Surgical Ward

“…have been commonly considered a relatively innocent bystander, this pattern of antimicrobial resistance to vancomycin and ampicillin (which is almost universal for E. faecium —the most common strain among VRE strains) leaves few therapeutic options for these patients [ 36 , 47 , 48 , 49 ]. These data on the increasing prevalence of VRE strains are in line with other recent evidence from Greece showing a high carriage of VRE strains either in terms of colonization or in terms of infections in the hospital setting in recent years [ 22 , 50 ]. Furthermore, the increase in the detection of VRE mandates the activation of infection control and antimicrobial stewardship in a local and possibly, a more generalized setting, since infection control measures could allow the reduction of the spread of these pathogens to other patients [ 51 ].…”

“…Regarding A. baumannii , antimicrobial resistance was high; however, when comparing with data from other wards of the same hospital and other hospitals in Greece, where resistance to carbapenems is 100%, the A. baumannii strains isolated from specimens in this surgical ward seemed to be more susceptible to antimicrobials [ 22 , 40 ]. In a point-prevalence study performed in the same hospital in Heraklion, as well as in other seven public hospitals in Crete, in a geographically isolated area within Greece, antimicrobial resistance of A. baumannii to carbapenems was 100%; however, in the current study, only 69% of the A. baumannii strains were resistant to meropenem [ 22 ]. This may imply that effective infection control practices in a ward may protect against the in-hospital spread of antimicrobial resistance even if predominance of a pan-drug-resistant strain in other wards of the same hospital has occurred.…”

“…Although there are published data on antimicrobial resistance in Greece, there is a paucity of data about antimicrobial resistance in surgical wards specifically, as the majority of the data are at the hospital level or may refer to wards in general, making no discrimination between medical and surgical wards, even though differences could occur between these two different settings [ 21 , 22 ].…”

Impact of SARS-CoV-2 Preventive Measures against Healthcare-Associated Infections from Antibiotic-Resistant ESKAPEE Pathogens: A Two-Center, Natural Quasi-Experimental Study in Greece

“…A previous cross-sectional investigation conducted in April 2022 in all eight public acute-care hospitals in Crete (including the two hospitals in the present study) provided indirect evidence that the prevalence of HAIs, albeit relatively high, remained constrained during the enormous pressure on the hospitals from COVID-19 pandemic [22]. The present study provides high-level evidence that there was a concomitant benefit of the COVID-19 prevention measures on the incidence density of antibiotic-resistant HAIs in two of those hospitals.…”

Special Issue: Recent Research on Hospital-Acquired Bloodstream Infections

“…In the last few decades, these infections have been the focus of clinicians, infection control nurses, and administrative agencies in attempts to reduce their incidence [ 4 ]. Point prevalence surveys in different hospitals and settings have demonstrated HAI rates between 5% and 12% [ 5 , 6 , 7 , 8 , 9 ], with bloodstream infections (BSIs) being the most common infections among HAIs [ 5 , 6 , 7 , 8 , 9 ]. BSIs can lead to death or significant complications if left untreated, such as endocarditis, spondylodiscitis, and meningitis [ 10 ].…”