Tracking infections in Belgian long-term care facilities: a one-year prospective study of incidence, duration, and clinical outcomes

Healthcare-associated infections (HAIs) are a public health issue in long-term care facilities (LTCFs), particularly among older adults. While European point prevalence surveys have described their distribution, comprehensive prospective data on incidence, duration, seasonality, and outcomes remain limited, especially in Belgium. This study aimed to describe the epidemiology and clinical outcomes of these infections in Belgian LTCFs over one year. A 12-month prospective study was conducted in four Belgian LTCFs where a selection of residents present at baseline were followed. Infections were recorded prospectively regardless of acquisition setting. Incidence densities were estimated per 1,000 resident-days using negative binomial regression (to account for overdispersion), while associations with outcomes were assessed using binomial logistic regression. Among 260 residents, 483 infections were reported in 199 (76.5%) individuals, corresponding to an incidence density of 5.7 per 1,000 resident-days. Respiratory tract infections were most frequent (31.3%; 1.8/1,000 resident-days), followed by COVID-19 (21.7%; 1.2/1,000 resident-days) and urinary tract infections (17.0%; 1.0/1,000 resident-days). The case-fatality rate of infections was 2.3%. Infections were strongly associated with hospitalisation (aOR 11.7%; 95CI: 6.5-20.8) and with increased mortality (aOR 4.0; 95% CI: 1.4-11.7). The association with mortality was mainly observed among residents who were not hospitalised following infection. This study showed a substantial infection burden, the observed associations with hospitalisation and mortality underline the clinical importance of infections in LTCFs. The results further support the implementation of strengthened longitudinal surveillance as well as focalised and seasonal infection prevention strategies. Finally, the organisational and resource challenges associated with the applied surveillance system are highlighted.