Hospital-acquired infections (HAIs) remain a significant threat to patient safety in Iran, with a recent study revealing consistently high rates of infection and escalating antibiotic resistance across key pathogens. The research, a retrospective analysis of data from 38 hospitals in Isfahan Province between 2019 and 2023, indicates that approximately 5% of patients experienced HAIs during the study period.
The study, which utilized data from the Health Deputy of Isfahan University of Medical Sciences, identified urinary tract infections (UTIs), pneumonia, and surgical site infections as the most prevalent types of HAIs. Pathogens responsible for these infections – including Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli – are demonstrating increasing resistance to commonly used antibiotics, particularly carbapenems and third-generation cephalosporins. Researchers employed microbiological and molecular techniques for pathogen identification, adhering to Clinical and Laboratory Standards Institute guidelines for antibiotic resistance testing.
Data from a 2023 national update on healthcare-associated infections in Iran, based on the Iranian Nosocomial Infection Surveillance (INIS) system, corroborates these findings. The INIS system, which gathers data from over 1,066 hospitals nationwide, reported 170,948 HAIs among more than 11 million hospitalized patients in 2023, translating to an incidence rate of 4.95 per 1,000 patient-days. Pneumonia accounted for 28.32% of these infections, followed by UTIs at 26.6% and surgical site infections at 21.85%.
The Isfahan Province study highlighted significant geographical disparities in infection rates, with intensive care units (ICUs) and transplant units exhibiting the highest incidence. Conversely, departments such as psychiatry, ear, nose, and throat (ENT), and ophthalmology reported comparatively lower rates. The study also noted demographic trends, with elderly patients (aged 65 and over) being disproportionately affected. Men were more susceptible to ventilator-associated pneumonia, although women were more prone to UTIs.
Alarmingly, the Isfahan study revealed a marked increase in antibiotic resistance among Gram-negative pathogens in 2023. Acinetobacter species displayed particularly high resistance levels, including 94.9% resistance to ceftazidime, 90.9% to fluoroquinolones, 84.9% to aminoglycosides, and 93.3% to carbapenems. While susceptibility to colistin remained relatively preserved at 3.8% resistance, resistance among Klebsiella species was also substantial, reaching 88.0% to third- and fourth-generation cephalosporins, and 86.6% to β-lactam/β-lactamase inhibitor combinations. Escherichia coli and Pseudomonas aeruginosa exhibited comparatively lower resistance rates across most antibiotic categories.
Researchers emphasize the urgent need for enhanced infection control measures, responsible antibiotic stewardship programs, and targeted strategies to mitigate the spread of HAIs and combat antibiotic resistance in Iranian hospitals. A qualitative study published in 2023 identified barriers to implementing effective surveillance systems in Iran, though specific details of those barriers were not included in the Isfahan Province study. The INIS system, as described in the 2023 national update, represents a nationwide effort to monitor and address these challenges.