Evaluation of epidemiological trend of repeated point-prevalence studies of healthcare-associated infections in a large teaching hospital

Background: Healthcare-Associated Infections (HAIs) are the most frequent adverse events in healthcare settings. They are associated with increased mortality and Antimicrobial Resistance (AMR), leading to prolonged hospital stays and consistent financial loss for healthcare systems. Similarly, Antimicrobial Use (AMU) and AMR represent a growing threat to global public health and the sustainability of healthcare services. Methods: The objective of this study is to estimate the burden of HAIs and antimicrobial use in the Teaching Hospital Policlinico Umberto I (THPUI) of Rome describing the trend of prevalence of HAIs across the years, comparing data about: a) patients; b) invasive procedures; c) infections; d) prescribed antimicrobials; e) clinical setting; f) risk factors for HAIs. Data were collected according to ECDC point prevalence survey protocol in the same months of four different years (2018, 2019, 2021, 2022). Descriptive statistics for all variables were calculated. Univariate analysis was used to assess possible associations between variables and HAIs. Variables with a significance level of p<0.25 were included in a multiple logistic regression model. Results: A total of 3086 patients were included in four repeated Point Prevalence studies from 2018 to 2022; 14.0% presented with at least one HAI. The prevalence of patients with HAI was 13.3% (106/799) in 2018, 11.1% (91/818) in 2019, 17.6% (131/745) in 2021, and 14.3% (104/725) in 2022. Bloodstream infections were the most common, accounting for 29.2% of total infections, followed by and pneumonia (26.6%) and urinary tract infections (21.8%). Overall, 502 microorganisms were isolated, with Enterobacteriaceae being the most frequent [39.0% (196/502)]. At the time of the survey, 48.9% (1508/3086) of patients were receiving antimicrobial therapy. The multivariate analysis showed a significant association between HAI and patients’ age (OR=1.01; 95% CI:1.00-1.01), hospitalization in intensive care unit (OR=2.39; 95% 1.73-3.30), NHSN surgery (OR=1.37; 95% CI:1.01-1.88), exposure to medical devices (OR=4.55; 95% CI:3.29-6.29), length of stay (OR=1.02; 95% CI:1.01-1.02) and exposure to prophylactic antimicrobial therapy (OR=0.45; 95% CI:0.33-0.62). Discussion: The ECDC methodology proved to be applicable to THPUI, where HAI prevalence was higher than the European standard. This highlights the need to implement targeted measures to prevent and control HAIs, including continuous monitoring to evaluate the effectiveness of such interventions and economic impact. This methodology 8 and related tools used in this study could be exported into other local and regional healthcare settings in order to create a standardized approach for the management of HAIs and to compare similar contexts.