Incidence and characteristics of health care-associated infection in hospitalized patients with rheumatic diseases in Alexandria Main University Hospital

Abstract

Introduction Health care-associated infection (HCAI) is an important cause of morbidity and mortality in patients with autoimmune diseases. Most previous reports investigated HCAI in the setting of systemic lupus erythematosus but lacked reports on other connective tissue diseases. Objectives We aimed to determine the incidence and characteristics of HCAI in patients with rheumatic diseases admitted to the Rheumatology Unit in Alexandria Main University Hospital in 2017. Patients and methods A 1-year duration prospective observational study was done to elucidate the incidence and characteristics of HCAI in patients with underlying rheumatic diseases who were admitted to our Rheumatology Unit between January 1 and December 31, 2017. Statistical analysis was performed using IBM SPSS Statistics 20. Data are presented as numbers and percentages for categorical variables and means and SDs for continuous variables. Results A total of 516 patients [423 (82%) female and 93 (18%) male] with underlying rheumatic diseases and disease duration of 6.03±4.18 years were admitted during the study period. The mean age was 32.18±9.54 years, and the mean length of hospitalization was 10.04±5.76 days. HCAI occurred in 14.9% (n=77) of patients, with 81 (15.69%) infection cases (four cases had more than one episode of infection in more than one site with a different organism during the same admission). Gram-negative bacilli were the most commonly isolated organisms (46.3%; n=38), and the urinary tract was the most commonly documented site of infection (39.5%; n=32). Klebsiella spp. (17.9%; n=15) was the most frequently identified infectious agent. Of the total cases with HCAI (n=77), 85.7% (n=66) were cured, 7.8% (n=6) deteriorated, 5.2% (n=4) died, and 1.3% (n=1) referred to another specialized hospital. Conclusion Despite the improvement in health care services, the incidence of HCAI infection in our inpatient population is still high and represents a burden on our resources. Although most cases were treated with appropriate antimicrobials, HCAI is still the cause of deterioration, and death occurred in a considerable percentage of patients with rheumatic diseases.

Keywords

• health care-associated infection
• incidence
• rheumatic diseases