Healthcare-associated infections at a Tunisian tertiary referral hospital: temporal trends and risk factors
Amal Ghribi, Houda Ben Ayed, Mariem Ben Hmida, Nouha Ketata, Mouna Baklouti, Ahmed Trigui, Ghada Nasri, Salima Bradai, Hanen Maamri, Sourour YaichAbstract
Objective:
To assess trends in healthcare-associated infection (HAI) prevalence, distribution by infection site and pathogen, and factors associated with HAI occurrence.
Design:
Five repeated point prevalence surveys (2017–2025).
Setting:
Hedi Chaker University Hospital, a tertiary-care teaching hospital in southern Tunisia.
Methods:
HAIs were defined per CDC/NHSN criteria. Temporal trends were assessed by Poisson regression and associated factors by multivariate logistic regression.
Results:
HAI prevalence increased significantly from 8.6% in 2017 to 21.8% in 2025 (Prevalence Ratio (PR) = 1.11; 95% CI: 1.06–1.15; P < .001), an estimated annual rise of 10%. Bloodstream infections (PR = 1.17; P = .004) and skin and soft tissue infections (PR = 1.17; P = .035) both increased significantly. Pneumonia and lower respiratory tract infections were the most frequent HAI type (26.2%). Among microbiologically documented HAIs (45.9%), Gram-negative bacilli predominated: Escherichia coli (23.5%), Pseudomonas aeruginosa (18.5%), and Klebsiella pneumoniae (17.6%). Multidrug-resistant (MDR) organisms accounted for 34.5% of isolates and increased significantly (PR = 1.12; P = .033). Independent risk factors were peripheral venous catheter use (Adjusted Odds Ratio (AOR) = 4.36; 95% CI: 2.78–6.84; P < .001), undernutrition (AOR = 2.02; 95% CI: 1.23–3.32; P = .005), and Intensive Care Unit admission (AOR = 2.08; 95% CI: 1.10–4.46; P = .048).
Conclusions:
HAI prevalence increased significantly from 2017 to 2025, with a sharp peak in 2025 and concurrent rises in bloodstream infections and MDR pathogens. These findings call for strengthened programs targeting modifiable risk factors and underscore the need for a national HAI surveillance network.