Health care-associated infections at an Egyptian tertiary care hospital: a 2-year prospective study

Abstract

Background Health care-associated infections (HAIs) are a health challenge. ObjectivesTo assess the incidence and patterns of HAIs and their relation to the length of hospital stay and underlying patient clinical status in tertiary care hospitals based on the surveillance system of Center for Disease Control and Prevention.Patients and methodsDuring the period from the November 2016 to December 2018, the active surveillance system of HAIs in Menoufia university hospitals' ICUs was assessed based on Center for Disease Control and Prevention rules.ResultsA total of 13 ICUs in four tertiary care university hospitals contributed to 93 280 patient days and revealed 36.7% of the patients with HAIs, where 33.1% were central line-associated bloodstream infections (CLABSI), 34.4% were ventilator-associated pneumonia (VAP), surgical site infections represented 19.1, and 13% were urinary tract infections. CLABSI had the highest rate of both the incidence of device-associated infection (58.5%) and incidence per 1000 device day (4.08). The total length of hospital stay in patients with HAIs (14.3 ± 23.8) was significantly higher than community-acquired infections (6.1 ± 2.5), and was observed in CLABSI (29.6 ± 18.3). The most frequent underlying medical conditions in CLABSI and VAP were diabetes mellitus (23.1 and 33.3%, respectively) and cirrhotic patients (17.3 and 10.4%, respectively). VAP had the highest in-hospital mortality rate (42.6%). Regarding antimicrobial resistance pattern, 86% of staphylococcal isolates and 94.6% of gram-negative isolates were multidrug resistant.ConclusionHAIs are a major burden in Egypt. In the studied hospitals, there is a high incidence of Staphylococcus aureus-associated BSI. Besides, a co-presence of gram-negative organisms with high rate of multidrug-resistance mandates the commitment to antimicrobial stewardship.