Palaiopanos Konstantinos, Krystallaki Dimitra, Mellou Kassiani, Kotoulas Petros, Kavakioti Christina-Anna, Vorre Styliani, Vertsioti Georgia, Gkova Maria, Maragkos Antonios, Tryfinopoulou Kyriaki, Paraskevis Dimitrios, Tsiodras Sotirios, Zaoutis Theoklis
Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece.
Central Public Health Laboratory, National Public Health Organization, Athens, Greece.
Antimicrob Resist Infect Control. 2024 Jan 25;13(1):11. doi: 10.1186/s13756-024-01367-8.
The burden of healthcare-associated infections (HAIs) and the extent of antimicrobial use (AU) are periodically recorded through Point Prevalence Surveys (PPS) in acute care hospitals coordinated by the European Centre for Disease Prevention and Control (ECDC). In previous PPSs, Greece demonstrated increased HAI and AU prevalence: 9% and 54.7% in 2011-2012, and 10% and 55.6% in 2016-2017, respectively. The 2022 PPS aimed to estimate HAIs and AU indicators among inpatients, especially amid the COVID-19 pandemic.
A cross-sectional study was conducted in 50 hospitals during October-December 2022, in Greece. Patients admitted before 8.00 a.m. of the survey day were observed. Patients with at least one HAI or receiving at least one antimicrobial agent were included. Data were collected by hospital infection control teams. Hospital and ward-level variables were analysed.
From 9,707 inpatients, 1,175 had at least one HAI (12.1%), and 5,376 were receiving at least one antimicrobial (55.4%). Intensive care unit patients had the highest HAI (45.7%) and AU (71.3%) prevalence. Of the 1,408 recorded HAIs, lower respiratory tract (28.9%), bloodstream (20%), and urinary tract infections (13.1%) were the most common. Among 1,259 isolates, Klebsiella (20.5%) and Acinetobacter (12.8%) were most frequently identified. Resistance to first-level antibiotic markers was 69.3%. Among the 9,003 antimicrobials, piperacillin-tazobactam (10.9%), and meropenem (7.7%) were frequently prescribed. The ratio of broad-spectrum to narrow-spectrum antibiotics was 1.4. As defined by the 2021 WHO AWaRe (Access, Watch, Reserve) classification, restricted classes of Watch and Reserve agents comprised 76.7% of antibiotics. Usual indications were treatment of community-acquired infections (34.6%) and HAIs (22.9%). For surgical prophylaxis, cefoxitin was commonly used (20.2%), and typical courses (75.7%) lasted more than one day. HAI and AU prevalence were positively associated with bed occupancy (p = 0.027) and secondary hospitals (p = 0.014), respectively.
The 2022 PPS highlighted the increasing trend of HAI prevalence and high AU prevalence in Greece, the emergence of difficult-to-treat pathogens, and the extensive use of broad-spectrum antimicrobials. Strengthening infection control and antimicrobial stewardship programs in hospital settings is essential.
欧洲疾病预防控制中心（ECDC）协调开展的急性护理医院点患病率调查（PPS）会定期记录医疗保健相关感染（HAIs）的负担以及抗菌药物使用（AU）情况。在以往的PPS中，希腊的HAI和AU患病率呈上升趋势：2011 - 2012年分别为9%和54.7%，2016 - 2017年分别为10%和55.6%。2022年的PPS旨在评估住院患者中的HAIs和AU指标，尤其是在新冠疫情期间。
2022年10月至12月在希腊的50家医院开展了一项横断面研究。观察调查日上午8点前入院的患者。纳入至少有1例HAI或正在接受至少1种抗菌药物治疗的患者。数据由医院感染控制团队收集。对医院和病房层面的变量进行分析。
在9707名住院患者中，1175人至少有1例HAI（12.1%），5376人正在接受至少1种抗菌药物治疗（55.4%）。重症监护病房患者的HAI（45.7%）和AU（71.3%）患病率最高。在记录的1408例HAIs中，下呼吸道感染（28.9%）、血流感染（20%）和尿路感染（13.1%）最为常见。在1259株分离菌株中，最常鉴定出的是克雷伯菌（20.5%）和不动杆菌（12.8%）。对一级抗生素标志物的耐药率为69.3%。在9003种抗菌药物中，哌拉西林 - 他唑巴坦（10.9%）和美罗培南（7.7%）的处方频率较高。广谱抗生素与窄谱抗生素的比例为1.4。按照2021年世界卫生组织AWaRe（获取、观察、储备）分类定义，观察类和储备类受限抗菌药物占抗生素的76.7%。常见的适应证是社区获得性感染的治疗（34.6%）和HAIs的治疗（22.9%）。对于手术预防，常用头孢西丁（20.2%），且典型疗程（75.7%）持续超过1天。HAI和AU患病率分别与床位占用率（p = 0.027）和二级医院（p = 0.014）呈正相关。
2022年的PPS突出了希腊HAI患病率上升趋势和高AU患病率、难治疗病原体的出现以及广谱抗菌药物的广泛使用。加强医院环境中的感染控制和抗菌药物管理计划至关重要。
