Trends and risk factors of multidrug-resistant hospital-acquired infections in a Tunisian university hospital: repeated point prevalence surveys, 2023-2025.
Salma Balhi, Sameh Boughattas, Mohamed Ben Rejeb, Asma Ben Cheikh, Nihel Haddad, Abdelhalim Trabelsi, Hela Ghali, Houyem Said Laatiri
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Abstract
Objective: To assess temporal trends in hospital-acquired infections (HAIs) prevalence, antimicrobial resistance (AMR) patterns, and associated risk factors of multidrug resistance (MDR)-related HAI in a Tunisian hospital between 2023 and 2025.
Design: Repeated point-prevalence surveys (PPSs).
Setting: Sahloul University Hospital, Sousse, Tunisia.
Patients: All patients hospitalized for more than 48 hours during each surveys.
Methods: Data on HAI prevalence, isolated pathogens, and AMR profiles were collected through three PPSs conducted annually from 2023 to 2025. HAIs were defined according to the criteria of the Centers for Disease Control and Prevention. MDR was defined as nonsusceptibility to at least one agent in three or more antimicrobial classes.
Results: From 2023 to 2025, 126 pathogens were responsible for 101 HAIs among 752 surveyed patients. The overall HAI prevalence was 10.9%, with no significant difference between the survey years (trend P = .430). Bloodstream infections were the most common type of HAI. Microbiological documentation was available for 94% of cases. Gram-negative bacteria predominated (72.2%) with Klebsiella pneumoniae (15%) as the leading pathogen. Overall, 41.2% of isolates were classified as MDR, with no significant trend over time (trend P = .068). Enterobacterales resistant to third-generation cephalosporins accounted for 14.3% (18/126) and carbapenem-resistant Enterobacterales for 7.9% (10/126).Prolonged hospital stay (>8 d) and ICU admission were independently associated with MDR-related HAIs (adjusted OR = 15.759, 95% CI: 3.691-67.285, P < .001 and OR = 3.612, 95% CI: 1.584-8.237, P = .002).
Conclusions: Repeated PPSs are an effective surveillance strategy for monitoring HAIs and AMR. These findings support the implementation of targeted antimicrobial stewardship and enhanced infection control interventions in Tunisian hospitals.
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