Seifi Arash, Zeinali Mohammad, Kamali Kianoush, Afhami Shirin, Rahnamaye-Farzami Marjan, Miladi Ronak, Shafaati Maryam
Center for Communicable Diseases Control (CDC), Ministry of Health and Medical Education, Tehran, Iran.
Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Infectious Diseases Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
J Epidemiol Glob Health. 2025 Sep 9;15(1):114. doi: 10.1007/s44197-025-00462-2.
Healthcare-associated infections (HCAIs) pose a serious threat to healthcare systems. Accurately determining the incidence of HCAIs is crucial for planning and implementing efficient interventions, as they are associated with a wide range of challenges. The objective of this study was to assess and update the incidence rates of HCAIs in Iran in 2023, using data from the Iranian Nosocomial Infection Surveillance (INIS) system, a nationwide hospital-based surveillance program.
The Iranian Center for Communicable Diseases Control (ICDC) evaluated data from 1,066 hospitals using the INIS software. Hospitals' trained infection control staff collected all information and entered it into the INIS. HCAIs were diagnosed based on the CDC/NHSN case definition criteria. We calculated incidence rate (per 100 admissions and per 1,000 patient-days).
We reported 170,948 HCAIs among 11,043,373 hospitalized patients, with an incidence rate of 4.95 per 1,000 patient-days, and the crude mortality rate of 19.85%. Looking at the relative frequencies, Pneumonia was the most frequent infection (28.32%), followed by urinary tract infections (UTIs) (26.6%), and surgical site infections (SSIs) (21.85%). HCAI rates were highest in intensive care units (ICUs), transplant wards, and burn units, with major surgeries like cardiovascular, neurosurgeries, and orthopedics having the highest SSI rates. The most common microorganisms were Klebsiella spp. (16.56%) and E. coli (14.6%), with high proportions of multidrug-resistance (MDR) including MRSA (43.2%), VRE (65.24%), and KPC (74.21%).
This study reveals a high incidence of HCAIs in Iranian hospitals in 2023, with pneumonia, UTIs, and SSIs being most common. The high proportion of MDR pathogens underscores the need for enhanced infection control, antibiotic stewardship program, and continuous staff education to reduce HCAIs and improve patient outcomes.
医疗保健相关感染（HCAIs）对医疗系统构成严重威胁。准确确定HCAIs的发病率对于规划和实施有效的干预措施至关重要，因为它们伴随着一系列广泛的挑战。本研究的目的是利用伊朗医院感染监测（INIS）系统的数据评估并更新2023年伊朗HCAIs的发病率，该系统是一项基于全国医院的监测计划。
伊朗传染病控制中心（ICDC）使用INIS软件评估了来自1066家医院的数据。医院经过培训的感染控制人员收集了所有信息并将其输入INIS。HCAIs根据美国疾病控制与预防中心/国家医疗安全网络（CDC/NHSN）的病例定义标准进行诊断。我们计算了发病率（每100次入院和每1000个患者日）。
在11043373名住院患者中，我们报告了170948例HCAIs，发病率为每1000个患者日4.95例，粗死亡率为19.85%。从相对频率来看，肺炎是最常见的感染（28.32%），其次是尿路感染（UTIs）（26.6%）和手术部位感染（SSIs）（21.85%）。HCAI发病率在重症监护病房（ICUs）、移植病房和烧伤病房最高，心血管、神经外科和骨科等大手术的SSI发病率最高。最常见的微生物是克雷伯菌属（16.56%）和大肠杆菌（14.6%），多重耐药（MDR）比例很高，包括耐甲氧西林金黄色葡萄球菌（MRSA）（43.2%）、耐万古霉素肠球菌（VRE）（65.24%）和产碳青霉烯酶肺炎克雷伯菌（KPC）（74.21%）。
本研究揭示了2023年伊朗医院HCAIs的高发病率，肺炎、UTIs和SSIs最为常见。MDR病原体的高比例凸显了加强感染控制、抗生素管理计划以及持续开展员工教育以减少HCAIs并改善患者预后的必要性。
