Prevalence of health care associated infections and antibiotic use among adult patients: Results of a cross-sectional survey at a tertiary university hospital in Tunisia

Abstract

Background: Healthcare-associated infections (HAIs) represent a major public health problem concern with a high attributable morbidity and mortality. This study aimed to estimate the prevalence of HAIs among adult patients at the Charles Nicolle Hospital (CNH) of Tunis and to identify the main associated factors as well as to estimate the frequency of antibiotic use. Methods: This was a cross sectional study at the CNH with a unique passage per department (October-December 2018). All patients present at the wards for more than 48 hours were included. The site definitions of infections proposed by the Centers for Disease Control and Prevention were used. Results: A total of 261 patients were included with a mean age of 52.4 years SD (±16.1) and a sex ratio (Female/Male) of 1.25. Overall, 34 patients having at least one active HAI were identified which represent a prevalence of 13% (95% CI [9.2 %–17.0 %]). The most common type of reported infections were urinary tract infections (33.3%) followed by surgical site infections (19.4%) and pneumonia (19.4%). Independent risk factors of high prevalence of HAIs among adults above 18 years old were: having hypertension (ORadjusted=3.3;p=0.008), alcohol use (ORadjusted=5.2; p=.01), being infected at admission (ORadjusted=2.8;p=0.01), having at least one invasive device inserted during last 7 days prior to the survey date (ORadjusted=3.5;p=0.004) and undergoing a surgery 30 days prior to the study date (ORadjusted=2.6;p=0.03). The antibiotic use prevalence was 32.2%. Conclusions: An infection prevention and control committee, as well as the development of an Antibiotic stewardship program with continuous monitoring using repeated prevalence surveys, must be implemented to limit the frequency of these infections effectively.