HAIs and antimicrobial use in long-term care: repeated prevalence surveys in north-eastern Italy
Abstract
Background: Healthcare-associated infections (HAIs) and antimicrobial use (AMU) in long-term care facilities (LTCFs) represent a growing public health concern, yet longitudinal surveillance data from this setting remain scarce, particularly at the subnational level.
Methods: Three repeated point prevalence surveys (PPSs) were conducted in LTCFs in the Autonomous Province of Trento (Italy) in 2019, 2022, and 2023, following the standardized ECDC HALT-3 protocol. For each survey year, HAI and AMU prevalence were estimated with exact binomial 95% confidence intervals. Facility-level Pearson correlation analyses explored associations between prevalence outcomes and selected resident- and facility-level indicators.
Results: Across the three surveys, 38, 32, and 39 LTCFs participated, covering 4,108, 2,766, and 3,610 eligible residents respectively. HAI prevalence was 3.8% (95% CI: 3.2–4.3) in 2019, 4.8% (95% CI: 4.1–5.8) in 2022, and 2.6% (95% CI: 2.1–3.2) in 2023. AMU prevalence followed a similar pattern: 4.0% (95% CI: 3.4–4.6), 4.5% (95% CI: 3.7–5.3), and 2.8% (95% CI: 2.3–3.4). Urinary tract infections and lower respiratory tract infections were the most frequently recorded HAI categories across all years. Penicillins combined with beta-lactamase inhibitors (8.5–15.6%) and third-generation cephalosporins (8.1–8.9%) were the most prescribed antibiotic classes. Missing data for indication and purpose of AMU were notably high in 2022 (47–48%), improving markedly in 2023. In 2022, significant negative facility-level correlations were observed between HAI prevalence and incontinence (r = −0.42; p = 0.02) and between AMU and urinary catheter use (r = −0.39; p = 0.03), likely reflecting ecological confounding.
Conclusions: HAI and AMU prevalence peaked in 2022, plausibly reflecting COVID-19-related disruption, and declined in 2023. Improving documentation completeness and reinforcing HAI prevention and control practices remain priorities for antimicrobial stewardship in LTCFs.
Key messages: • HAIs and AMU prevalence peaked in 2022 and declined in 2023 in LTCFs in north-eastern Italy, highlighting the impact of COVID-19 disruption on infection burden, consistent with European trends.
• Repeated PPSs reveal persistent gaps in antimicrobial documentation and broad-spectrum prescribing in LTCFs, underscoring the need for targeted stewardship programs addressing both practices.
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BibTeX
@article{tussardi2026hais,
title = {{HAIs and antimicrobial use in long-term care: repeated prevalence surveys in north-eastern Italy}},
author = {I Tocco Tussardi and M Arshad and D Visentin and A Arlanch and E Torri and S Minervini and L Fabbri and L Cazzoletti and S Tardivo},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1608},
url = {https://doi.org/10.1093/eurpub/ckag169.1608},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - HAIs and antimicrobial use in long-term care: repeated prevalence surveys in north-eastern Italy
AU - I Tocco Tussardi
AU - M Arshad
AU - D Visentin
AU - A Arlanch
AU - E Torri
AU - S Minervini
AU - L Fabbri
AU - L Cazzoletti
AU - S Tardivo
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1608
UR - https://doi.org/10.1093/eurpub/ckag169.1608
AB - Background: Healthcare-associated infections (HAIs) and antimicrobial use (AMU) in long-term care facilities (LTCFs) represent a growing public health concern, yet longitudinal surveillance data from this setting remain scarce, particularly at the subnational level. Methods: Three repeated point prevalence surveys (PPSs) were conducted in LTCFs in the Autonomous Province of Trento (Italy) in 2019, 2022, and 2023, following the standardized ECDC HALT-3 protocol. For each survey year, HAI and AMU prevalence were estimated with exact binomial 95% confidence intervals. Facility-level Pearson correlation analyses explored associations between prevalence outcomes and selected resident- and facility-level indicators. Results: Across the three surveys, 38, 32, and 39 LTCFs participated, covering 4,108, 2,766, and 3,610 eligible residents respectively. HAI prevalence was 3.8% (95% CI: 3.2–4.3) in 2019, 4.8% (95% CI: 4.1–5.8) in 2022, and 2.6% (95% CI: 2.1–3.2) in 2023. AMU prevalence followed a similar pattern: 4.0% (95% CI: 3.4–4.6), 4.5% (95% CI: 3.7–5.3), and 2.8% (95% CI: 2.3–3.4). Urinary tract infections and lower respiratory tract infections were the most frequently recorded HAI categories across all years. Penicillins combined with beta-lactamase inhibitors (8.5–15.6%) and third-generation cephalosporins (8.1–8.9%) were the most prescribed antibiotic classes. Missing data for indication and purpose of AMU were notably high in 2022 (47–48%), improving markedly in 2023. In 2022, significant negative facility-level correlations were observed between HAI prevalence and incontinence (r = −0.42; p = 0.02) and between AMU and urinary catheter use (r = −0.39; p = 0.03), likely reflecting ecological confounding. Conclusions: HAI and AMU prevalence peaked in 2022, plausibly reflecting COVID-19-related disruption, and declined in 2023. Improving documentation completeness and reinforcing HAI prevention and control practices remain priorities for antimicrobial stewardship in LTCFs. Key messages: • HAIs and AMU prevalence peaked in 2022 and declined in 2023 in LTCFs in north-eastern Italy, highlighting the impact of COVID-19 disruption on infection burden, consistent with European trends. • Repeated PPSs reveal persistent gaps in antimicrobial documentation and broad-spectrum prescribing in LTCFs, underscoring the need for targeted stewardship programs addressing both practices.
SN - 1101-1262
SN - 1464-360X
ER -