Mapping the landscape of healthcare-associated infections in China, 2015-2019: a nation-wide observational study.

Abstract

<h4>Background</h4>Healthcare-associated infections (HAIs), complicated by antimicrobial resistance continue to affect all countries with unprecedented threat, especially for developing countries. Our objective was to explore the epidemiological features, spatiotemporal heterogeneity and associated factors of HAIs and HAI related multi-drug resistant organisms (MDROs) in China.<h4>Methods</h4>We used national surveillance data that were collected from 6867 sampled hospitals during 2015-2019 to determine the annual incidence of HAIs, key HAI-related quality indicators and associated factors.<h4>Findings</h4>During 2015-2019, total of 4,959,230 HAIs were reported in sampled hospitals in China, with the overall incidence and prevalence estimated as 1.1 and 2.3 per 100 inpatients, which showed decline trend over time. Carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) had the highest overall detection rate (51.1%), followed by methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) (31.0%), carbapenem-resistant <i>Pseudomonas aeruginosa</i> (CRPA) (22.8%), and carbapenem-resistant <i>Klebsiella pneumonia</i> (CRKP) (12.4%). Detection rates of MRSA, carbapenem-resistant <i>Escherichia coli</i> (CREC), and vancomycin-resistant <i>Enterococcus faecium</i> (VREfm) reduced, in contrast with an increasing trend for CRKP. Higher risk of HAIs was associated with hospitals located in urban areas (incidence rate ratio [IRR]: 1.39, p < 0.001), in regions with higher GDP per capita (IRR: 1.03, p < 0.001), with more beds (IRR: 1.64 and 2.16 for 500-1500 and ≥ 1500 beds respectively, p < 0.001), as well as in south region of China (IRR: 1.23, p < 0.001). The reduced annual rates of HAIs were observed after 2017 (IRR: 0.92, p < 0.001), when 12 new standards targeted for HAIs were implemented.<h4>Interpretation</h4>The study increases the understanding of HAIs and antimicrobial resistance. It highlights high-risk areas of HAIs and MDROs of concern, where targeted measures to continuously enhance management and policies implementation of HAIs are needed.<h4>Funding</h4>The Foundation of State Key Laboratory of Pathogen and Biosecurity of China (Grant No. SKLPBS2443) and Infection Prevention and Control Research Project of "Gan·Dong China" (Grant No. GY2023022-A).