Health care-associated infections in neonatal intensive care units in public hospitals, South Ethiopia: Incidence, risk factors, and outcomes during 2017-2022.

Background: The extent of hospital-associated infections (HAIs) in low-income settings remains largely unknown and underestimated. Our aim is to describe the burden of HAIs associated with hospitalization in neonatal intensive care units (NICUs) in Sidama Region, Ethiopia.

Methods: We performed a retrospective cohort study at the NICUs of 4 purposely selected public hospitals among 5,216 neonates admitted over a 5-year period (2017-2022). Neonatal surveillance registers were reviewed and patients' characteristics, HAIs incidence, risk factors, and outcomes of infections were recorded. Bayesian logistic regression analyses were used to control potential confounders.

Results: Among 5,216 neonates (52,514 observed patient-days), 2,079 cases of HAI were observed (40%), equivalent to 39.59 per 1,000 patient-days. The neonatal mortality rate was 105 deaths per 1,000 live births. Over the 5-year period, the infection rate decreased overall. Risk factors for HAIs were hospital type, place of delivery, antibiotic treatment, and low-birth-weight babies 2,000 to < 2,500 g.

Conclusions: We found a high incidence of HAIs in NICUs, and HAIs-related deaths were unexpectedly high. Hospital type, place of birth, birth weight, and inappropriate use of antibiotic treatment were risk factors for HAIs. Emphasis should be given to reduce inappropriate antibiotic use and focus on risk factors.