HEALTHCARE-ASSOCIATED INFECTIONS AND ANTIMICROBIAL PRESCRIBING PATTERNS IN TWO ACUTE CARE HOSPITAL CENTERS

Abstract

Introduction: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose major threats to patient safety worldwide. This study aimed to determine the prevalence and distribution of HAIs, as well as to characterize clinical profiles and risk factors in two acute-care hospital centers in Albania. Methodology: A multicenter, cross-sectional Point Prevalence Survey (PPS) was conducted, applying the standardized protocol of the European Centre for Disease Prevention and Control (ECDC, Version 6.1). The sample included 648 patients admitted to the "Mother Teresa" University Hospital Center (MTUHC, n=511) and the Durrës Regional Hospital (RHD, n=137). Modified Poisson regression was used to identify independent predictors of HAIs, calculating adjusted prevalence ratios (aPR) with 95% confidence intervals (CI). Results: The overall prevalence of HAIs was 6.3% (95% CI: 4.4–8.1%), with a higher rate at the tertiary level (MTUHC: 6.7%) compared to the regional level (RHD: 5.1%). Pneumonia was the most frequent infection (41.5%), followed by surgical site infections (26.8%) and urinary tract infections (19.5%). The rate of microbiological confirmation was critically low, occurring in only 14.6% of clinically identified cases. Multivariate analysis confirmed that a hospital stay of 8–14 days (aPR=2.9, 95% CI: 1.12–7.5, p=0.03), a hospital stay of ≥ 3 weeks (aPR=5.4, 95% CI: 2.1–13.8, p<0.001), presence of a central vascular catheter (aPR=2.1, 95% CI: 1.1–4.3, p=0.010), urinary catheter catheter (aPR=3.8, 95% CI: 1.9–7.5, p=0.002) and intubation (aPR=2.6, 95% CI: 1.1–6.5, p=0.03) were the primary independent predictors of HAIs. Stratified analysis showed that the effects of these risk factors remain homogeneous and are not significantly modified by the type of hospital (p > 0.05). Conclusions: This pilot study provides baseline evidence regarding the epidemiological burden of HAIs in Albania. The findings highlight an urgent need to strengthen diagnostic laboratory capacities and to implement rigorous active surveillance and antimicrobial stewardship programs at all levels of hospital care.