Hospital-acquired infections associated to COVID-19 intensive care unit at a Tunisian hospital: Determinants factors

Introduction: Hospital-acquired infections pose a serious challenge to healthcare workers during the COVID-19 pandemic. Objectives: We aimed at assessing associated factors to hospitalacquired infection in the COVID-19 Intensive Care Unit (ICU) in the region of Mahdia (Tunisia). Methods: We conducted a prospective study from September 2020 to February 2021 among COVID-19 patients in the ICU of the University Hospital Taher Sfar Mahdia from hospital admission to discharge or death. We used the “Rapid core case report form” developed by World Health Organization (WHO) for the COVID-19 data plateform. Results: A total of 114 patients were enrolled with a mean age of 61.28 ± 12.19 years and median length stay of 14 days (IQR 9-24). Diabetes (43.4%) and hypertension (38.6%) were the most frequent underlying diseases. Fifty-four patients (54.2%) developed nosocomial infection after a median of 7 days (IQR 4-11) of admission. Pneumonia (29.8%) and bacteremia (28%) were the most common infection sites. In 34.2% of cases, infection was related to resistant bacteria (100% of multi-resistance for Acinetobacter baumanii and 90.5% for Klebsiella pneumonia). Infection was significantly associated with severe acute respiratory distress syndrome (OR 4.4, 95% CI 1.3-10.9, p = 0.018) and longer invasive ventilation (more than 7 days) (OR 10.4, 95% CI 9.7-20.5, p < 0.001). Conclusion: Measures to reduce Hospital-acquired infections such as implementing antimicrobial stewardship programmes are needed in order to achieve better therapeutic outcomes.