Healthcare-associated infections and antimicrobial use in acute care hospitals in Greece, 2022; results of the third point prevalence survey

Antimicrobial Resistance & Infection Control Pub Date : 2024-01-25 DOI:10.1186/s13756-024-01367-8

Konstantinos Palaiopanos, Dimitra Krystallaki, Kassiani Mellou, Petros Kotoulas, Christina-Anna Kavakioti, Styliani Vorre, Georgia Vertsioti, Maria Gkova, Antonios Maragkos, Kyriaki Tryfinopoulou, Dimitrios Paraskevis, Sotirios Tsiodras, Theoklis Zaoutis

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Abstract

The burden of healthcare-associated infections (HAIs) and the extent of antimicrobial use (AU) are periodically recorded through Point Prevalence Surveys (PPS) in acute care hospitals coordinated by the European Centre for Disease Prevention and Control (ECDC). In previous PPSs, Greece demonstrated increased HAI and AU prevalence: 9% and 54.7% in 2011–2012, and 10% and 55.6% in 2016–2017, respectively. The 2022 PPS aimed to estimate HAIs and AU indicators among inpatients, especially amid the COVID-19 pandemic. A cross-sectional study was conducted in 50 hospitals during October-December 2022, in Greece. Patients admitted before 8.00 a.m. of the survey day were observed. Patients with at least one HAI or receiving at least one antimicrobial agent were included. Data were collected by hospital infection control teams. Hospital and ward-level variables were analysed. From 9,707 inpatients, 1,175 had at least one HAI (12.1%), and 5,376 were receiving at least one antimicrobial (55.4%). Intensive care unit patients had the highest HAI (45.7%) and AU (71.3%) prevalence. Of the 1,408 recorded HAIs, lower respiratory tract (28.9%), bloodstream (20%), and urinary tract infections (13.1%) were the most common. Among 1,259 isolates, Klebsiella (20.5%) and Acinetobacter (12.8%) were most frequently identified. Resistance to first-level antibiotic markers was 69.3%. Among the 9,003 antimicrobials, piperacillin-tazobactam (10.9%), and meropenem (7.7%) were frequently prescribed. The ratio of broad-spectrum to narrow-spectrum antibiotics was 1.4. As defined by the 2021 WHO AWaRe (Access, Watch, Reserve) classification, restricted classes of Watch and Reserve agents comprised 76.7% of antibiotics. Usual indications were treatment of community-acquired infections (34.6%) and HAIs (22.9%). For surgical prophylaxis, cefoxitin was commonly used (20.2%), and typical courses (75.7%) lasted more than one day. HAI and AU prevalence were positively associated with bed occupancy (p = 0.027) and secondary hospitals (p = 0.014), respectively. The 2022 PPS highlighted the increasing trend of HAI prevalence and high AU prevalence in Greece, the emergence of difficult-to-treat pathogens, and the extensive use of broad-spectrum antimicrobials. Strengthening infection control and antimicrobial stewardship programs in hospital settings is essential.

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2022 年希腊急症护理医院的医源性感染和抗菌药使用情况；第三次点流行率调查结果

在欧洲疾病预防与控制中心（ECDC）的协调下，通过在急症护理医院进行的点流行率调查（PPS），定期记录医疗相关感染（HAIs）的负担和抗菌药使用（AU）的程度。在以往的点流行率调查中，希腊的HAI和AU流行率有所上升：2011-2012年分别为9%和54.7%，2016-2017年分别为10%和55.6%。2022 PPS旨在估算住院病人的HAI和AU指标，尤其是在COVID-19大流行期间。2022 年 10 月至 12 月期间，在希腊的 50 家医院开展了一项横断面研究。调查对象为调查日上午 8:00 之前入院的患者。其中包括至少发生过一次 HAI 或至少接受过一次抗菌药物治疗的患者。数据由医院感染控制小组收集。对医院和病房层面的变量进行了分析。在 9,707 名住院患者中，1,175 人至少患有一种 HAI（12.1%），5,376 人至少服用了一种抗菌药物（55.4%）。重症监护室患者的 HAI（45.7%）和 AU（71.3%）发生率最高。在记录的 1,408 例 HAI 中，下呼吸道感染（28.9%）、血流感染（20%）和尿路感染（13.1%）最为常见。在 1,259 个分离菌株中，克雷伯氏菌（20.5%）和醋酐菌（12.8%）最常见。对一级抗生素标记的耐药性为 69.3%。在 9 003 种抗菌药物中，哌拉西林-他唑巴坦（10.9%）和美罗培南（7.7%）是常用处方药。广谱抗生素与窄谱抗生素的比例为 1.4。根据 2021 年世界卫生组织 AWaRe（准入、观察、储备）分类的定义，受限制的观察类和储备类药物占抗生素的 76.7%。通常的适应症是治疗社区获得性感染（34.6%）和人感染性疾病（22.9%）。手术预防常用头孢西丁（20.2%），一般疗程（75.7%）超过一天。HAI 和 AU 感染率分别与病床占用率（p = 0.027）和二级医院（p = 0.014）呈正相关。2022年PPS强调了希腊HAI感染率和AU感染率不断上升的趋势、难以治疗的病原体的出现以及广谱抗菌药物的广泛使用。在医院环境中加强感染控制和抗菌药物管理计划至关重要。

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Antimicrobial Resistance & Infection Control

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