HAIs and antimicrobial use in long-term care: repeated prevalence surveys in north-eastern Italy

Background

Healthcare-associated infections (HAIs) and antimicrobial use (AMU) in long-term care facilities (LTCFs) represent a growing public health concern, yet longitudinal surveillance data from this setting remain scarce, particularly at the subnational level.

Methods

Three repeated point prevalence surveys (PPSs) were conducted in LTCFs in the Autonomous Province of Trento (Italy) in 2019, 2022, and 2023, following the standardized ECDC HALT-3 protocol. For each survey year, HAI and AMU prevalence were estimated with exact binomial 95% confidence intervals. Facility-level Pearson correlation analyses explored associations between prevalence outcomes and selected resident- and facility-level indicators.

Results

Across the three surveys, 38, 32, and 39 LTCFs participated, covering 4,108, 2,766, and 3,610 eligible residents respectively. HAI prevalence was 3.8% (95% CI: 3.2–4.3) in 2019, 4.8% (95% CI: 4.1–5.8) in 2022, and 2.6% (95% CI: 2.1–3.2) in 2023. AMU prevalence followed a similar pattern: 4.0% (95% CI: 3.4–4.6), 4.5% (95% CI: 3.7–5.3), and 2.8% (95% CI: 2.3–3.4). Urinary tract infections and lower respiratory tract infections were the most frequently recorded HAI categories across all years. Penicillins combined with beta-lactamase inhibitors (8.5–15.6%) and third-generation cephalosporins (8.1–8.9%) were the most prescribed antibiotic classes. Missing data for indication and purpose of AMU were notably high in 2022 (47–48%), improving markedly in 2023. In 2022, significant negative facility-level correlations were observed between HAI prevalence and incontinence (r = −0.42; p = 0.02) and between AMU and urinary catheter use (r = −0.39; p = 0.03), likely reflecting ecological confounding.

Conclusions

HAI and AMU prevalence peaked in 2022, plausibly reflecting COVID-19-related disruption, and declined in 2023. Improving documentation completeness and reinforcing HAI prevention and control practices remain priorities for antimicrobial stewardship in LTCFs.

Key messages

• HAIs and AMU prevalence peaked in 2022 and declined in 2023 in LTCFs in north-eastern Italy, highlighting the impact of COVID-19 disruption on infection burden, consistent with European trends.

• Repeated PPSs reveal persistent gaps in antimicrobial documentation and broad-spectrum prescribing in LTCFs, underscoring the need for targeted stewardship programs addressing both practices.