Abstract
Hospital-acquired Respiratory-Tract Infections (HARTIs) are identified as the most frequent type of hospital-acquired infections. They can engender significant morbidity and mortality rates, generating a heavy economic burden, especially in the limited resources countries. In this perspective, this study aimed to determine the prevalence of HARTIs in the University Hospitals (UHs) of Southern Tunisia and to identify their main associated factors. It was a cross-sectional study conducted in the two UHs of Sfax governorate, Tunisia, from July 10 to 24th, 2017, including all hospitalized patients for at least 48 hours. It was a 1-day pass per department and a 1-week survey per UH. In total, 34 cases of HARTIs were notified among 752 surveyed patients, accounting for an overall prevalence of 4.5%. The prevalence of HARTIs in the Intensive Care Units (ICU) was 20.6%. Multivariate logistic regression analysis showed that developing a HARTI in non-ICU was independently associated with tobacco use [Adjusted Odds Ratio (AOR) = 2.83; 95% Confidence Interval (95% CI) = [1.10–7.27]; p = 0.03], central vascular catheter (AOR = 5.70; 95% CI = [1.29–25.15];p = 0.022) and McCabe Index ≥1 (AOR = 7.38; 95% CI = [2.73–19.97];p < 0.001). In ICU, only endotracheal tube was independently associated with HARTIs (AOR = 42.5; 95% CI = [4.97–64.13]; p = 0.001). This study illustrated the extent of HARTIs problem threatening the quality of care in Southern Tunisia. Identifying the risk factors of HARTIs in both ICUs and non-ICUs may help healthcare workers to ascertain the avoidability of these infections.
Article PDF
Avoid common mistakes on your manuscript.
Data availability statement
The data that support the findings of this study are available from the corresponding author [MBJ], upon reasonable request.
References
World Health Organization (WHO). Health care-associated infections. Fact Sheet. Geneva: WHO; 2016.
European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. ECDC; 2013. Available from: https://www.ecdc.europa.eu/en/healthcare-associated-infections-acute-care-hospitals/surveillance-disease-data/report (accessed January 15, 2020).
Tao XB, Qian LH, Li Y, Wu Q, Ruan JJ, Cai DZ, et al. Hospital-acquired infection rate in a tertiary care teaching hospital in China: a cross-sectional survey involving 2434 inpatients. Int J Infect Dis 2014;27;7–9.
Annabi Attia T, Dhidah L, Hamza R, Kibech M, Lepoutre-Toulemon A. The first Tunisian national prevalence survey of nosocomial infections: main results. Hygiènes 2007;15;144–9.
Chinsky KD. Ventilator-associated pneumonia: is there any gold in these standards?. Chest 2002;122;1883–5.
Bhadade R, Harde M, deSouza R, More A, Bharmal R. Emerging trends of nosocomial pneumonia in intensive care unit of a tertiary care public teaching hospital in Western India. Ann Afr Med 2017;16;107–13.
Walaszek M, Kosiarska A, Gniadek A, Kolpa M, Wolak Z, Dobroś W, et al. The risk factors for hospital-acquired pneumonia in the Intensive Care Unit. Przegl Epidemiol 2016;70;15–20, 107–10.
McEachern R, Campbell GD. Hospital-acquired pneumonia: epidemiology, etiology, and treatment. Infect Dis Clin North Am 1998;12;761–79.
Ige OK, Adesanmi AA, Asuzu MC. Hospital-acquired infections in a Nigerian tertiary health facility: an audit of surveillance reports. Niger Med J 2011;52;239–43.
Amazian K, Rossello J, Castella A, Sekkat S, Terzaki S, Dhidah L, et al. Prévalence des infections nosocomiales dans 27 hôpitaux de la région méditerranéenne. East Mediterr Health J 2010;16; 1070–8.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16;128–40.
Kofteridis DP, Papadakis JA, Bouros D, Nikolaides P, Kioumis G, Levidiotou S, et al. Nosocomial lower respiratory tract infections: prevalence and risk factors in 14 Greek hospitals. Eur J Clin Microbiol Infect Dis 2004;23;888–91.
McCabe WR, Jackson GG. Gram-negative bacteremia: I. Etiology and ecology. Arch Intern Med 1962;110;847–55.
Ben Cheikh A, Ben Rejeb M, Ghali H, Chelly S, Khefacha S, Said Latiri H. Healthcare-associated infections in a Tunisian University Hospital in 2017: prevalence and risk factors. Rev Epidemiol Sante Publ 2018;66;S395.
Thiolet JM, Vaux S, Lamy M, Gauthier A, Barret AS, Leon L. National point prevalence survey of healthcare-associated infections and antimicrobial use in French care settings, May to June 2012. Sante Publique France; 2018. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/infections-associees-aux-soins-et-resistance-aux-antibiotiques/infections-associees-aux-soins/documents/rapport-synthese/enquete-nationale-de-prevalence-des-infections-nosocomiales-et-des-traitements-anti-infectieux-en-etablissements-de-sante-france-mai-juin-2012.-r (accessed February 15, 2020).
Zarb P, Coignard B, Griskeviciene J, Muller A, Vankerckhoven V, Weist K, et al. The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill 2012;17;20316.
Razine R, Azzouzi A, Barkat A, Khoudri I, Hassouni F, Chefchaouni AC, et al. Prevalence of hospital-acquired infections in the university medical center of Rabat, Morocco. Int Arch Med 2012;5;26.
Yallew WW, Kumie AK, Yehuala FM. Point prevalence of hospital-acquired infections in two teaching hospitals of Amhara region in Ethiopia. Drug Healthc Patient Saf 2016;8;71–6.
Kakupa DK, Muenze PK, Byl B, Wilmet MD. [Study of the prevalence of nosocomial infections and associated factors in the two university hospitals of Lubumbashi, Democratic Republic of Congo: case of the University Clinics of Lubumbashi and the Janson Sendwe Hospital]. Pan Afr Med J 2016;24;275.
Centers for Disease Control and Prevention. Guidelines for prevention of nosocomial pneumonia. MMWR Recomm Rep 1997;46;1–79.
Medell M, Hart M, Duquesne A, Espinosa F, Valdés R. Nosocomial ventilator-associated pneumonia in Cuban intensive care units: bacterial species and antibiotic resistance. MEDICC Rev 2013;15;26–9.
Bagaitkar J, Demuth DR, Scott DA. Tobacco use increases susceptibility to bacterial infection. Tob Induc Dis 2008;4;12.
Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, et al. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can J Infect Dis Med Microbiol 2008;19;19–53.
Guzman-Herrador B, Molina CD, Allam MF, Navajas RFC. Independent risk factors associated with hospital-acquired pneumonia in an adult ICU: 4-year prospective cohort study in a university reference hospital. J Public Health 2016;38;378–83.
Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R, CDC, et al. Guidelines for preventing health-care—associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004;53;1–36.
Keyt H, Faverio P, Restrepo MI. Prevention of ventilator-associated pneumonia in the intensive care unit: a review of the clinically relevant recent advancements. Indian J Med Res 2014;139;814–21.
Author information
Authors and Affiliations
Corresponding author
Additional information
Peer review under responsibility of the Dr. Sulaiman Al Habib Medical Group
Rights and permissions
This is an open access article distributed under the CC BY-NC 4.0 license (https://doi.org/creativecommons.org/licenses/by-nc/4.0/).
About this article
Cite this article
Jmaa, M.B., Yaich, S., Ayed, H.B. et al. Hospital-acquired Respiratory-Tract Infections in the Teaching Hospitals of Sfax. Dr. Sulaiman Al Habib Med J 3, 113–119 (2021). https://doi.org/10.2991/dsahmj.k.210719.001
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.2991/dsahmj.k.210719.001