Healthcare-associated infections and antimicrobial use: Siena 2012

Background Healthcare-associated infections (HAI) and antimicrobial resistance of ‘‘bugs’’ represent important public health problems. HAI are associated with increases in mortality, morbidity, length of hospital stay and costs. The aims of this study were to determine the prevalence of HAI and the use of antimicrobial agents (AA) in an Italian teaching hospital. Methods Cross sectional study. We participated at the project ‘‘Hospitals in Europe Link for Infection Control through Surveillance’’, ed. 2012, by the European Centre for Disease Prevention and Control (ECDC). Medical records (MR) collection was carried out in all the wards, in the period 19 to 30 November 2012. Case definitions, inclusion/exclusion criteria and data collections were defined by a protocol. Descriptive analysis and comparison with international literature were made. Results 467 MR were collected. 32 HAI were identified. 224 patients were receiving AA. The most common type of HAI was pneumonia/respiratory 9/ 32 (28,1%) followed by bloodstream and urinary tract infections, both 4/32 (12,5%,) and decubitus ulcers 3/32 (9,4%). The most commonly microorganisms identified were Staph.Aureus (17,1%), followed by:E.Coli (14,3%), Candida Albicans and Staph.Epidermidis (both 11,4%), Pseudomonas Aeruginosa (8,6%), Clostr.Difficile and Kleb.Pneumoniae (both 5,7%). The most widely used AA were -Lactam antibiotics, (including penicillin derivates 77/303, cephalosporins 75/303 and Carbapenems 28/303) followed by fluoroquinolones 42/ 303 and glycopeptide antibiotics 27/303. The reason for AA use was included in patients’ MR only in 38,3% of cases. Surgical prophylaxis, prolonged for more than 1 day (30,7%), was the most common reason for AA use. Other reasons were: treatment of HAI (21,4%) and medical prophylaxis/treatment of community infection (both 19,5%). Conclusions Our results are partially in line with European ones. Urinary tract emerged to be less common in our experience. This positive results could be attributable to a better sensitization to this problem in our Hospital. Microorganisms responsible for HAI and AA used were similar to those detected in Europe. Attentions have to be particularly addressed to microorgan- isms which became resistant also because of the misuse of AA. Key messages Prevalence of HAI recorded by us does not seem greater than European data. However in Italy some studies reported an increase of resistant bacteria. We reported that reasons for antimicrobial agents (AA) use were included in only 38,3% patients’ medical records. This is relevant: the overuse/misuse of AA, may cause increase of resistant bacteria.