Burden of Healthcare-Associated Infections and Antimicrobial Resistance in a Romanian Cardiovascular and Transplant Center: Factors Associated with Mortality.

Abstract

Background/objectives: Healthcare-associated infections (HAIs) are a major burden in tertiary hospitals, particularly in high-risk populations such as cardiovascular and transplant patients. The emergence of antimicrobial resistance (AMR) further complicates management, contributes to poor outcomes and increases costs. This study aimed to describe the burden of HAIs, the antimicrobial resistance patterns of the main pathogens, and to identify predictors of mortality among patients hospitalized in a Romanian cardiovascular and transplant center.

Methods: We conducted a retrospective study including all patients with HAIs reported to the Infection Prevention and Control Service of the Emergency Institute for Cardiovascular Diseases and Transplantation, Târgu Mureș, Romania, between 2023 and the first quarter of 2025. Descriptive statistics summarized demographic and clinical data. Univariable and multivariable logistic regression were used to assess risk factors for mortality. Antimicrobial resistance was evaluated through cumulative antibiograms.

Results: A total of 139 HAIs were reported during the study period, with a prevalence of 1.05% in 2023 and 1.0% in 2024. The most common pathogens were SARS-CoV-2 (15%), Klebsiella pneumoniae (14%), and Acinetobacter baumannii (13%). Overall, all-cause in-hospital mortality was 32%, with 30% of deaths associated with A. baumannii and 27% with K. pneumoniae. More than half of bacterial isolates were resistant to multiple antibiotic classes; 22% were extensively drug-resistant. ICU admission and treatment with more than three antibiotics were independently associated with mortality.

Conclusions: Although the prevalence of HAIs in our study was low, the cases that occurred in cardiovascular and transplant patients were often severe, frequently involved multidrug-resistant organisms, and were associated with high mortality. Strengthening infection prevention and antimicrobial stewardship is essential to reduce the impact of HAIs in this vulnerable population.