Prepandemic National Prevalence of Hospital Acquired Infections, Risk Factors and Antibiotic Resistance in Tunisia

Background: In Tunisia, there is a poorness of data describing prepandemic Hospital Acquired Infections (HAIs). Aim: This study aims to describe prevalence and distribution of HAIs in Tunisian public and private hospitals and to identify their main risk factors. Methods: A point-prevalence national cross-sectional survey was conducted between November and December 2012. Data were collected using a standardized protocol of the Centre for Disease Control (CDC) Atlanta. Results: A total of 132 hospitals representing 67.4% beds in public and private hospitals were surveyed. Of 8608 inpatients included, 575 had at least one HAI corresponding to an overall prevalence of 6.7%. The main factors associated to HAIs were hospitalization in intensive care unit (AOR=3.4 [1.8-6.4]), suprapubic aspiration (AOR=5.3 [2.2-12.5]), central vascular catheter (AOR=3.8 [2.7-5.4]), malnutrition (AOR=1.9 [1.3-2.6]) and immunosuppression (AOR=1.9 [1.5-2.6]. Out of the 575 patients, 199 had a microbiological test (34.6%). One microorganism was identified in 68% of cases, two in 31.5% and three and more in other cases. The most common microorganism was Klebsiella Pneumoniae. The national prevalence of antimicrobial use was 43.0% (95%CI [42.0%-44.0%]). Antibiotic resistance phenotypes were identified in 82.6% of isolated bacteria. Conclusion: Our results highlighted the need to implement targeted prevention control measures especially an early warning system for HAIs in departments at risk and a national antibiotic stewardship program to fight against emergence and spread of multi-resistant bacteria.