# Surveillance of Healthcare-Associated Infections in Long-Term Care Facilities in Graz, Austria, from 2018 to 2022

## TL;DR

This study tracked healthcare-associated infections and antibiotic use in Austrian long-term care facilities from 2018 to 2022, finding a significant rise during the pandemic.

## Contribution

The study provides a detailed, longitudinal analysis of HCAI trends and antimicrobial prescriptions in LTCFs during the early years of the pandemic.

## Key findings

- The overall HCAI rate increased significantly from 2018 to 2022, reaching 4.09/1000 resident days in 2022.
- Respiratory tract infections spiked in winter 2021/2022 due to SARS-CoV-2, and UTIs were the most common infections.
- Beta-lactam prescriptions increased significantly, while quinolone prescriptions decreased between 2018 and 2022.

## Abstract

Objectives: This study aimed to evaluate changes in the rate and spectrum of healthcare-associated infections (HCAIs) and to analyse the rate and spectrum of antimicrobial prescriptions in four long-term care facilities (LTCFs) in Graz, Austria, from 2018 to 2022 in a prospective cohort study. Methods: Nursing staff prospectively collected data on HCAIs and antimicrobial prescriptions once a week. Log-linear Poisson models for counts were applied mostly to evaluate the difference effects of the various calendar years compared to the reference year of 2018. Results: A total of 1684 infections were recorded in 720 residents during the study period. The overall annual incidence rate of HCAIs varied over time with a significant increase to 2.86/1000 resident days in 2019 and to 4.09/1000 resident days in 2022, both compared to 2018, p < 0.001. A large peak in respiratory tract infections (RTIs) occurred in winter 2021/2022 due to a large number of SARS-CoV-2 infections in all four LTCFs. Urinary tract infections (UTIs) were the most commonly recorded infections. Beta-lactams were the most frequently prescribed systemic anti-infectives. A statistically significant increase in the rate of beta-lactam prescriptions/1000 resident days occurred between 2018 and 2022 (p = 0.016), whereas a statistically significant decrease in quinolone prescriptions/1000 resident days occurred in the same time period (p < 0.001). Conclusions: The incidence rates of HCAIs varied over time with a significant increase during the COVID-19 pandemic in 2022 compared to 2018. Continued surveillance efforts are necessary to assess the effect of infection control efforts after the pandemic.