Trends of Healthcare-associated Infections in a Tuinisian University Hospital and Impact of COVID-19 Pandemic

Abstract

Background Although efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning. Aim To describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI. Methods The current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors. Results Overall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% ( P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98). Conclusion Contrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.

Predictors and Outcomes of Healthcare-Associated Infections among Patients with COVID-19 Admitted to Intensive Care Units in Punjab, Pakistan; Findings and Implications

“…Similarly, Falcone et al (2020) reported high rates at 71.6% among patients with COVID-19 admitted to ICUs in participating Italian hospitals [ 64 ]. Our findings also contrast with those of Ghali et al (2021) in Tunisia where HAIs were seen in 35.1% of patients in ICU with COVID-19 [ 24 ], and with de Hesselle et al (2022) among patients critically ill in ICUs enrolled into the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) study [ 27 ]. Secondary bacterial infections were documented in the critical phase in 40.4% of cases in this study, and secondary fungal infections in 14.6% of cases [ 27 ].…”

“…These findings are similar to those of Grasselli et al (2021) [ 4 ], with high rates of HAIs seen among ventilated patients in the studies of de Hesselle et al (2022) [ 27 ], Bardi et al (2021) [ 52 ] and Falcone (2020) et al [ 64 ]. There findings are also similar to a study from Tunisia where frequent HAIs reported among hospitalized COVID-19 patients admitted to ICU were pneumonia/ lower respiratory tract infections followed by urinary tract infections [ 24 ]. Following guidelines, including following recommendations regarding catheter placements and care, can help to reduce these HAIs [ 3 ].…”

“…HAIs can develop in a hospital setting in patients receiving health care after 48 h or more after hospital admission [ 23 , 24 ]. Invasive devices, which include vascular devices, urinary catheters and ventilators employed in the medical care of patients, are associated with these HAIs [ 25 , 26 , 27 ].…”

The impact of COVID-19 on multidrug-resistant organisms causing healthcare-associated infections: a narrative review

“…HAIs have increased with COVID-19 worldwide. 3–12 This change was most notable for CLABSIs, which increased in Europe 11 , 13 , 14 and the USA in 2020 and 2021, 7–10 , 15–17 with a particularly concerning rise in candidaemia. 18–22 In the USA, this rise reversed almost 5 years of reduction in rates of CLABSI.…”

Co-occurrence of antibiotic and metal resistance in long-term sewage sludge-amended soils: influence of application rates and pedo-climatic conditions

“…This indicates that the actual counts of ARB in the sludge sample were largely influenced by the period and site of study, the origin of collected effluents and the fate of antibiotics in relation with wastewater treatment technologies and USS storage conditions at WWTPs (Harrabi et al 2018). In any case, recent local reports indicate that the excessive use of antibiotics and subsequent microbial resistance have been further aggravated since 2020 with COVID-19 infections being mostly treated using cefotaxime, ofloxacin and azithromycin (Ben Saida et al 2020;Ghali et al 2021).…”