A 2022 point-prevalence survey (PPS) in Greek hospitals found rising rates of healthcare-associated infections (HAIs), high resistance to first-line antibiotics, and extensive use of broad-spectrum antibiotics, researchers reported last week in Antimicrobial Resistance and Infection Control.
The cross-sectional study, conducted in 50 of the 126 hospitals of the Greek National Health Care system from October through December 2022, collected data on HAIs and antibiotic use among patients admitted before 8:00 am on the day of the survey. In a 2016-2017 PPS conducted by the European Centre for Disease Prevention and Control, Greece was among the countries with the highest prevalence of HAI (10%) and antibiotic use (55.6%).
Of the 9,707 inpatients included in the study, 1,175 (12.1%) had an HAI and 5,376 (55.4%) were receiving at least on antibiotic. Lower respiratory tract (28.9%), bloodstream (20%), and urinary tract infections (13.1%) were the most common HAIs. Intensive care unit patients had the highest HAI (45.7%) and antibiotic use (71.3%) prevalence. Gram-negative bacteria were the most frequent source of HAIs (58.4% of total isolates), with Klebsiella (20.5%) and Acinetobacter (12.8%) the most frequently identified. The prevalence of resistance to first-level antibiotic markers was 69.3%.
Extensive use of broad-spectrum antibiotics
Among the 9,003 antimicrobials recorded, piperacillin-tazobactam (10.9%) and meropenem (7.7%) were the most frequently prescribed, and the ratio of broad-spectrum to narrow-spectrum antibiotics was 1.4. As defined by the World Health Organization's AWaRe (Access, Watch, and Reserve) classification system, Watch and Reserve antibiotics constituted 76.7% of all antibiotics prescribed. The WHO suggests that at least 60% of antibiotics consumed at the national level come from the Access group.
"The 2022 PPS study highlights the significant challenge that HAIs pose in patient care in Greece," the study authors wrote. "It clearly indicates an increased burden of HAIs together with the emergence of difficult-to-treat pathogens in inpatients, as well as the extensive use of broad-spectrum antimicrobials."
The authors say strengthening infection prevention and control and antimicrobial stewardship in these settings is essential.
The 2022 PPS study highlights the significant challenge that HAIs pose in patient care in Greece.