More high-risk patients but stable levels of healthcare-associated infections and antibiotic use: findings from national point prevalence survey conducted in 2017 and 2022 in the Paris region hospitals

Abstract

Monitoring healthcare-associated infections (HAI) and antibiotic use (ABU) in hospitalized patients is essential to control infections and reduce the inappropriate use of antibiotics. This study aimed to describe trends in the prevalence of HAI and ABU between 2017 and 2022 within a group of healthcare facilities in the Paris region. The study focused on data collected during point-prevalence surveys (PPS) conducted in hospitals in 2017 and 2022. Only facilities participating in both surveys and departments enrolling at least 10 patients were included in the analysis. Patient characteristics, HAI, and ABU were compared between 2017 and 2022, excluding COVID-19 infections in 2022, except in cases of co-infection with an HAI. Multivariate regression analysis was performed to measure the prevalence of HAI and ABU. Overall, 79 facilities were included representing 19 211 patients in 2017 and 16 266 in 2022. The overall HAI prevalence remained stable at 6.7%, despite an increase in patient risk factors, including higher proportions of immunocompromised patients (17.5% vs. 16.2%, p = 0.001) and greater use of invasive devices (48.1 vs. 42.6%, p < 0.001). Pneumonia prevalence increased in 2022 (1.3% vs. 1.1%, p = 0.03). In paediatric units, HAI prevalence decreased markedly (1.1% vs. 4.2%, p < 0.001). The prevalence of patients receiving antibiotics was also stable (20.3% in 2017; 21.1% in 2022). In 2022, monotherapy was more frequent (73.8% vs. 71.0%, p = 0.001), and intravenous administration increased (60.0% vs. 53.7%, p < 0.001). The use of fluoroquinolones and aminoglycosides have declined (5.8% vs. 8.3% and 1.6% vs. 3.0%, p < 0.001). The prevalence of patients receiving antibiotics declined in gynaecology-obstetrics (10.8% vs. 14.0%, p = 0.021). Factors significantly associated with HAI and ABU included gender, McCabe score, immunosuppression, cancer and vascular catheterization. After adjustment for these factors, HAI prevalence was significantly lower in 2022 than in 2017 (prevalence ratio 0.91, p = 0.033). In this group of Paris-area hospitals, the stability in HAI in 2022 compared with the 2017 PPS, despite an increase in patient risk factors, may reflect an improvement in infection prevention practices. The overall prevalence of ABU remained stable but changes in molecular class indicated that prescribing practices improved. Efforts must continue with the support of mobile teams specialising in infection control and prevention and antibiotic stewardship.