Background: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose significant challenges in healthcare systems worldwide, leading to prolonged hospital stays, increased costs, and elevated morbidity and mortality rates. The 2017 European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) revealed a 5.9% HAI prevalence in European acute care hospitals, with Belgium reporting a higher rate of 7.3%. Additionally, in 2017, a crude prevalence of 28.1% of inpatients receiving at least one antimicrobial was recorded in Belgian hospitals. In 2022, the ECDC PPS was repeated in Belgian acute care hospitals to reassess both HAI prevalence and antimicrobial use.
Methods: Data collection for the 2022 survey was conducted from September to November, following the ECDC protocol (version 6.0) at hospital/ward/patient levels. Modifications from the 2017 protocol included updated infection definitions and microorganism codes for COVID-19, along with the incorporation of HAIs associated with long-term care facilities.
Findings: A total of 56 acute care hospital sites participated, encompassing 10,142 patients. The 2022 survey revealed that 9.2% (95% confidence interval (CI): 8.7-9.8%) of patients had at least one HAI. This prevalence was 8.5% (95% CI: 7.5-9.5%) when excluding HAI associated with long-term care facilities. Predominant infections included pneumonia and lower respiratory tract infections (32.8%, including COVID-19 infections at 8.5%), surgical site infections (13.6%), urinary tract infections (18.5%), bloodstream infections (12.2%) and gastrointestinal infections (9.0%). Microbiological results were positive for 65.6% of HAIs, with Escherichia coli, Staphylococcus aureus, and Klebsiella spp. being the most common isolates.
Regarding antimicrobial use, the survey found that 29.3% (95% CI: 28.4-30.2%) of patients were receiving at least one antimicrobial, with higher prevalence observed in patients over 65 years (31.1%). Intensive care units (56.3%) and surgical wards (38.7%) demonstrated the highest antimicrobial use prevalence, while psychiatric wards exhibited the lowest (3.0%). Common indications for antimicrobial treatment included community-acquired infections (48.6%) and HAIs (26.1%). Indication for surgical prophylaxis was recorded for 12.4% of prescribed antimicrobials. Notably, 22.7% of surgical prophylaxis courses lasted more than one day. The top three most prescribed antimicrobial agents were amoxicillin in combination with a beta-lactamase inhibitor, cefazolin, and piperacillin in combination with a beta-lactamase inhibitor.
Conclusion: The 2022 ECDC PPS revealed an increased prevalence of both HAIs and antimicrobial use in Belgian acute care hospitals compared to previous surveys. This emphasizes the ongoing need for rigorous infection prevention and control measures, as well as robust antimicrobial stewardship programs, to address these challenges effectively. Future investigations should focus on prescription attitudes and modifiable practices to optimize patient outcomes and mitigate the spread of AMR.
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