Healthcare infections and antimicrobial consumption in pre-COVID-19 era: a point prevalence survey in three hospitals in a region of central Italy


antimicrobial stewardship

Healthcare Associated Infections
antibiotics prescription


Healthcare-associated infections (HAIs) are a major global public health concern, increasing the transmission of drug-resistant infections. This point prevalence survey investigated HAIs occurrence and antimicrobial consumption (AMC) in pre-COVID-19 era in the public hospitals of a region of Central Italy. Data were collected using the protocol standardised by the European Centre for Disease Prevention and Control. Three-hundred and sixty-four patients were included (59.3% male) in the study. Overall, HAIs prevalence was 6.6% (95%CI 4.4-9.5), ranging from 5.2% to 7.1% within the surveyed hospitals, with at least one infection in 24 patients (ten each in medical and surgical specialties wards, and four in intensive care). Risk factors for HAIs were advanced age, having undergone surgery and wearing invasive devices. At time of the survey, 44.7% (95%CI 39.7-49.9) of patients was under treatment with at least one antibiotic, and AMC varied between 43% and 48% within hospitals. In all hospitals, a prevalence higher than 10% was found for the prescription reasons other than prophylaxis or therapy. The results revealed a HAIs prevalence lower than that estimated compared to the most recent national data, in contrast to higher antimicrobial usage. These findings highlight the need to reinforce hygiene practices and develop bundles for HAIs, as a broad implementation of infection prevention and control practices extensively applied to both hub and spoke hospitals could significantly reduce their occurrence, as well as to implement antimicrobial stewardship for prescriptive appropriateness.


Shafer CW, Allison JR, Hogue AL, Huntington MK. Infectious Disease: Health Care-Associated Infections. FP Essent 2019;476:30-42.

Nimer NA. Nosocomial Infection and Antibiotic-Resistant Threat in the Middle East. Infect Drug Resist 2022;15:631-639. doi: 10.2147/IDR.S351755.

Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022;399(10325):629-55. doi: 10.1016/S0140-6736(21)02724-0.

Stevens MP, Doll M, Pryor R, Godbout E, Cooper K, Bearman G. Impact of COVID-19 on traditional healthcare-associated infection prevention efforts. Infect Control Hosp Epidemiol 2020;41(8):946-947. doi: 10.1017/ice.2020.141.

Ghosh S, Bornman C, Zafer MM. Antimicrobial Resistance Threats in the emerging COVID-19 pandemic: Where do we stand? J Infect Public Health 2021;14(5):555-560. doi: 10.1016/j.jiph.2021.02.011.

Saleem Z, Godman B, Hassali MA, Hashmi FK, Azhar F, Rehman IU. Point prevalence surveys of health-care-associated infections: a systematic review. Pathog Glob Health 2019;113(4):191-205. doi: 10.1080/20477724.2019.1632070.

Ripabelli G, Salzo A, Mariano A, Sammarco ML, Tamburro M. Collaborative Group for HAIs Point Prevalence Surveys in Molise Region. Healthcare-associated infections point prevalence survey and antimicrobials use in acute care hospitals (PPS 2016-2017) and long-term care facilities (HALT-3): a comprehensive report of the first experience in Molise Region, Central Italy, and targeted intervention strategies. J Infect Public Health 2019;12(4):509-515. doi: 10.1016/j.jiph.2019.01.060.

European Centre for Disease Prevention and Control. Studio di prevalenza europeo sulle infezioni correlate all’assistenza e sull’uso di antibiotici negli ospedali per acuti. Stockholm, ECDC 2016. Available at: Accessed on April 6, 2022.

Morehead MS, Scarbrough C. Emergence of Global Antibiotic Resistance. Prim Care 2018;45(3):467-484. doi: 10.1016/j.pop.2018.05.006.

Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, Jans B, Hopkins S, Hansen S, Lyytikäinen O, Reilly J, Deptula A, Zingg W, Plachouras D, Monnet DL. Healthcare-Associated Infections Prevalence Study Group. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill 2018;23(46):1800516. doi: 10.2807/1560-7917.ES.2018.23.46.1800516.

Arnoldo L, Smaniotto C, Celotto D, Brunelli L, Cocconi R, Tignonsini D, Faruzzo A, Brusaferro S; FVG Regional ‘Safety Care’ Group. Monitoring healthcare-associated infections and antimicrobial use at regional level through repeated point prevalence surveys: what can be learnt? J Hosp Infect 2019;101(4):447-454. doi: 10.1016/j.jhin.2018.12.016.

Vilches TN, Bonesso MF, Guerra HM, Fortaleza CMCB, Park AW, Ferreira CP. The role of intra and inter-hospital patient transfer in the dissemination of heathcare-associated multidrug-resistant pathogens. Epidemics 2019;26:104-115. doi: 10.1016/j.epidem.2018.11.001.

Antonioli P, Bolognesi N, Valpiani G, Morotti C, Bernardini D, Bravi F, Di Ruscio E, Stefanati A, Gabutti G. A 2-year point-prevalence surveillance of healthcare-associated infections and antimicrobial use in Ferrara University Hospital, Italy. BMC Infect Dis 2020;20(1):75. doi: 10.1186/s12879-020-4791-8.

Ripabelli G, Tamburro M, Guerrizio G, Fanelli I, Flocco R, Scutellà M, Sammarco ML. Tracking Multidrug-Resistant Klebsiella pneumoniae from an Italian Hospital: Molecular Epidemiology and Surveillance by PFGE, RAPD and PCR-Based Resistance Genes Prevalence. Curr Microbiol 2018;75(8):977-987. doi: 10.1007/s00284-018-1475-3.

Ripabelli G, Salzo A, Sammarco ML, Guerrizio G, Cecere G, Tamburro M. Infections and Colon Surgery: Preliminary Results from a Surveillance Program in an Italian Hospital. Hosp Top 2023;101(1):27-38. doi: 10.1080/00185868.2021.2006103.

Monegro AF, Muppidi V, Regunath H. Hospital Acquired Infections. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.

Salzo A, Ripabelli G, Sammarco ML, Mariano A, Niro C, Tamburro M. Healthcare-Associated Infections and Antibiotics Consumption: A Comparison of Point Prevalence Studies and Intervention Strategies. Hosp Top 2021;99(3):140-150. doi: 10.1080/00185868.2021.1902758.

Russo Fiorino G, Maniglia M, Marchese V, Aprea L, Torregrossa MV, Campisi F, Favaro D, Calamusa G, Amodio E. Healthcare-associated infections over an eight year period in a large university hospital in Sicily (Italy, 2011-2018). J Infect Prev 2021;22(5):220-230. doi: 10.1177/17571774211012448.

Plachouras D, Kärki T, Hansen S, Hopkins S, Lyytikäinen O, Moro ML, Reilly J, Zarb P, Zingg W, Kinross P, Weist K, Monnet DL, Suetens C; Point Prevalence Survey Study Group. Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill 2018;23(46):1800393. doi: 10.2807/1560-7917.ES.23.46.1800393.

International Society for Infectious Diseases (ISID). Guide to infection control in the healthcare setting. Hand hygiene. 2018. Available at: Accessed on May 1, 2022.

Schuts EC, Hulscher MEJL, Mouton JW, Verduin CM, Stuart JWTC, Overdiek HWPM, van der Linden PD, Natsch S, Hertogh CMPM, Wolfs TFW, Schouten JA, Kullberg BJ, Prins JM. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis 2016;16(7):847-856. doi: 10.1016/S1473-3099(16)00065-7.

Hansen S, Schwab F, Gastmeier P; PROHIBIT study group; Pittet D, Zingg W, Sax H, Gastmeier P, Hansen S, Grundmann H, van Benthem B, van der Kooi T, Dettenkofer M, Martin M, Richet H, Szilágyi E, Központ OE, Heczko PB, Holmes A, Kyratsis Y, Ahmad R, Allegranzi B, Magiorakos A, Cookson B, Wu AW. Provision and consumption of alcohol-based hand rubs in European hospitals. Clin Microbiol Infect 2015;21(12):1047-51. doi: 10.1016/j.cmi.2015.09.019.

Yazici G, Bulut H. Efficacy of a care bundle to prevent multiple infections in the intensive care unit: A quasi-experimental pretest-posttest design study. Appl Nurs Res 2018;39:4-10. doi: 10.1016/j.apnr.2017.10.009.

Nathwani D, Varghese D, Stephens J, Ansari W, Martin S, Charbonneau C. Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review. Antimicrob Resist Infect Control 2019;8:35. doi: 10.1186/s13756-019-0471-0.

Echevarria K, Groppi J, Kelly AA, Morreale AP, Neuhauser MM, Roselle GA. Development and application of an objective staffing calculator for antimicrobial stewardship programs in the Veterans Health Administration. Am J Health Syst Pharm 2017;74(21):1785-1790. doi: 10.2146/ajhp160825.