Trends in healthcare-associated infections and antimicrobial-resistant organisms among adults in Canadian acute care hospitals: findings from four point prevalence surveys, 2002 to 2024

TL;DR

This study tracks changes in hospital infections and antibiotic resistance in Canada from 2002 to 2024, showing some increases despite pandemic challenges.

Contribution

The study provides the first comprehensive trend analysis of HAIs and AROs in Canadian hospitals over two decades using repeated point prevalence surveys.

Findings

The prevalence of healthcare-associated infections (HAIs) increased from 10.4% in 2002 to 12.4% in 2009 but decreased to 8.4% in 2017 and stabilized at 8.1% in 2024.

There was a significant increase in central line-associated bloodstream infections (CLABSIs) and viral respiratory infections (VRIs) between 2017 and 2024.

Antimicrobial-resistant organisms (AROs) were responsible for 6.6% of infections in 2024.

Abstract

To describe trends in the prevalence of healthcare-associated infections (HAIs) and antibiotic-resistant organisms (AROs) in Canadian acute-care hospitals.

Repeated point prevalence surveys.

Canadian Nosocomial Infection Surveillance Program (CNISP) hospitals.

Trained infection control professionals reviewed medical records of eligible adult patients and applied standardized definitions to collect demographic data and information on HAIs, AROs, and additional precautions from 39 to 62 hospitals in 2002, 2009, 2017, and 2024.

The prevalence of adult patients with at least one HAI increased from 10.4% (95% CI: 9.6%–11.2%) in 2002 to 12.4% (95% CI: 11.7%–13.2%) in 2009, declined to 8.4% (95% CI: 7.8%–9.0%) in 2017, and stabilized in 2024 (8.1%, 95% CI: 7.6%–8.6%) despite 3.1% of HAIs being due to SARS-CoV-2. Between 2017 and 2024, there were increases in bloodstream infections (1.0% to 1.5%, p = 0.002), viral respiratory infections (VRI) (0.3% to 0.6%, p < 0.001), and in the prevalence of patients on additional precautions for carbapenemase-producing organisms (0.1% to 1.7%, p < 0.001) and VRIs (2.1% to 3.6%, p < 0.001). In 2024, AROs were responsible for 6.6% of infections. One-third of HAIs were device-associated, and the prevalence of central line-associated bloodstream infections (CLABSIs) doubled from 0.4% in 2017 to 0.7% in 2024, p = 0.02.

A point prevalence survey performed in Canada in 2024 following the COVID-19 pandemic identified a stable prevalence of HAIs and AROs despite the inclusion of SARS-CoV-2. Concerning trends were observed including the increased prevalence of certain HAIs such as CLABSIs and VRIs highlighting the need for ongoing efforts in hospital infection prevention.

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