Point Prevalence Study of Healthcare-Associated Infections and Antimicrobial Use in Belgian Acute-Care Hospitals: Results of the ECDC PPS 2017

<p>Background:</p> <p>In 2011, the first European point prevalence study (PPS) of antimicrobial use and healthcare-associated infections (HAIs) was organised by the European Centre for Disease Prevention and Control (ECDC). In the participating Belgian acute care hospital sites (N=52, September-December 2011), the prevalence of patients with at least one antimicrobial and at least one HAI was 28.9% (95% confidence interval (CI): 26.8-31.1%) and 7.1% (95% CI: 6.1-8.3%), respectively. The objective of this report is to present the results of the second ECDC PPS conducted in 2017 in Belgian acute care hospitals.</p> <p>Methods:</p> <p>All Belgian acute care hospitals were invited to participate in the ECDC PPS 2017. In addition, a representative random sample of hospitals was selected which received an individualized invitation to participate. Training was provided to the participating hospitals in September 2017, followed by the data collection between September and November 2017. Data were collected at hospital, ward and patient levels. All patients who were present on the ward at 8h00 a.m. on the day of the PPS and who were not discharged at the time of the survey had to be included. Data collection had to be performed on one single day per ward, within a maximum period of 2 to 3 weeks for each hospital.</p> <p>Results:</p> <p>In total, 47 acute care hospital sites (33 mergers, of which 22 primary, 9 secondary and 2 tertiary hospitals, countrywide participation 32.4%) participated in the ECDC PPS (11800 patients included, mean age 60.2±25.3 year, 55.2% females). The crude prevalence of patients with at least one antimicrobial agent was 28.1% (95% CI: 27.3-29.0%). Medical prophylaxis, surgical prophylaxis and treatment of HAIs were reported as indication in 6.2%, 13.5% and 24.2% of the prescribed antimicrobial agents (N=4103), respectively. The top 3 of most used antimicrobial agents consisted of amoxicillin in combination with a beta-lactamase inhibitor (J01CR02, 19.7%), cefazolin (J01DB04, 9.7%) and piperacillin in combination with a beta-lactamase inhibitor (J01CR05, 7.7%). The most frequently reported diagnoses for medical antimicrobial treatment were pneumonia (22.2%) and urinary tract infections (11.2%). The reason for antimicrobial use was available in 80.8% of the medical notes.</p> <p>A crude prevalence of patients with at least one HAI of 7.3% (95% CI: 6.8-7.7%) was detected. The most frequently reported HAIs (N=911) were pneumonia (21.6%), urinary tract infections (21.3%) and surgical site infections (16.9%). Microbiological results were available for 62.0% of the HAIs. A total of 721 microorganisms were reported. The most commonly isolated microorganism was Escherichia coli (17.8%).</p> <p>Conclusions:</p> <p>In comparison with the Belgian results of the ECDC PPS in 2011, the prevalence of antimicrobial consumption and the prevalence of HAI remained the same. The reasons for the high prevalence of HAIs should be further investigated and targets should be set to improve. It is recommended that hospitals participate regulary in a PPS.</p>