Health care-associated infections, including device-associated infections, and antimicrobial resistance in Iran: The national update for 2018

INTRODUCTION: Surveillance of health care-associated infections (HAIs) is an essential part of an efficient healthcare system. This study is an update on incidence and mortality rates of HAIs in Iran in 2018. METHODS: Almost all hospitals across the country (940 hospitals) entered the data of HAIs and denominators to the Iranian Nosocomial Infections Surveillance (INIS) software. Statistics were derived from INIS. RESULTS: From 9,607,213 hospitalized patients, 127,953 suffered from HAI, 15.65% of whom died. The incidence rate of HAI was calculated as 4.2 per 1000 patient-days. Considering relative frequencies among HAIs, Pneumonia (29.1%) and UTIs (25.6%) were the most common types of infection. Ventilator-associated pneumonia (VAP) was the most frequent device-associated infection (DAI) 25.66 per 1000 ventilator-days, and had the highest mortality rate (43.08%). Incidence density of other DAIs was 5.43 for catheter-associated UTI and 2.86 for catheter-associated BSI per 1000 device-days. Medical ICUs had the highest incidence and percentage of deaths (15.35% and 37.63%, respectively). The most causative organisms were Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumonia. The rate of methicillin-resistance Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria was about 49%, 57%, and 58% respectively. CONCLUSION: This study provided an overview of HAIs in Iran and indicated that HAIs required special attention both in detection/reporting and in infection control measures. Future studies could be done on adherence rate of DAIs’ preventive bundles, interventions via multimodal strategies, evaluating the effect of training, and effect of antibiotic stewardship programs.