Background: Hospital-acquired infections (HAIs) pose a significant danger to global public health, mainly because their numbers are growing exponentially each year. Additionally, the rise of bacterial strains resistant to current treatment options further exacerbates this threat. This study aimed to examine the occurrences of HAIs identified in public hospitals at the county level. Methods: We conducted a cross-sectional study utilizing data provided to the Mures Public Health Directorate from all the public hospitals within the studied county. We examined HAIs reported during the period spanning from 2017 to 2021, which amounted to a total of 4603 cases. Results: The medical departments reported the highest prevalence of HAIs at 48.25%. The most common infections included enterocolitis with Clostridioides difficile (32.61%), COVID-19 (19.83%), bronchopneumonia (16.90%), sepsis, surgical wound infections, and urinary tract infections. The five most frequently identified pathogens were Clostridioides difficile (32.61%), SARS-CoV-2 (19.83%), Acinetobacter baumannii (11.82%), Klebsiella pneumoniae (9.58%), and Pseudomonas aeruginosa (7.95%). Acinetobacter baumannii was the predominant agent causing bronchopneumonia, while Klebsiella pneumoniae was the leading cause of sepsis cases. Escherichia coli was the primary agent behind the urinary tract infections, and Staphylococcus aureus MRSA was identified as the main etiology for wound infections and central catheter infections. Throughout the study period, there was a significant rise in Clostridioides difficile and Gram-negative bacteria prevalence rates. Conclusions: This study identified increased Clostridioides difficile in HAI cases during COVID-19, highlighting the need for careful antibiotic use and emphasizing the growing challenge of multi-resistant strains in post-pandemic state hospitals.

Background: Hospital-acquired infections (HAI) pose a significant danger to global public health, mainly because their numbers are growing exponentially each year. Additionally, the rise of bacterial strains resistant to current treatment options further exacerbates this threat. The study aimed to examine the occurrences of HAIs identified in public hospitals at the county level. Methods: We conducted a cross-sectional study utilizing data provided to the Mures Public Health Directorate from all the public hospitals within this county. We examined HAIs reported during the period spanning from 2017 to 2021, which amounted to a total of 4603 cases. Results: The medical departments reported the highest prevalence of HAIs at 48.25%. The most common infections in-cluded enterocolitis with Clostridioides difficile (32.61%), COVID-19 (19.83%), bronchopneumonia (16.90%), sepsis, surgical wound infections, and urinary tract infections. The five most frequently identified pathogens were Clostridioides difficile (32.61%), SARS-CoV-2 (19.83%), Acinetobacter baumannii (11.82%), Klebsiella pneumoniae (9.58%), and Pseudomonas aeruginosa (7.95%). Acinetobacter baumannii was the predominant agent causing bronchopneumonia, while Klebsiella pneumoniae was the leading cause of sepsis cases. Escherichia coli was the primary agent behind urinary tract infec-tions, and Staphylococcus aureus MRSA was identified as the main etiology for wound infections and central catheter infections. Throughout the study period, there was a significant rise in Clostridioides difficile cases, accounting for 40.36% of all reported HAIs in 2021. Conclusions: The study identifies Clostridioides difficile increase in HAI cases during COVID-19, highlighting the need for careful antibiotic use, and emphasizing the growing challenge of multi-resistant strains in post-pandemic state hospitals.

Background: Healthcare-associated infections (HAIs), particularly those caused by antimicrobial-resistant pathogens, remain an important cause of adverse outcomes among hospitalized patients. The combined contribution of antimicrobial resistance, clinical characteristics, and antimicrobial treatment to mortality requires further evaluation. This study aimed to investigate factors associated with in-hospital mortality among patients with HAIs, with particular emphasis on multidrug resistance (MDR) and post-culture antimicrobial treatment. Methods: We conducted a retrospective observational cohort study that included 192 patients with 242 documented HAI episodes in a hospital in Târgu-Mureș, Romania. Demographic and clinical characteristics, invasive procedures, microbiological findings, antimicrobial resistance phenotypes, antimicrobial exposure, and in-hospital outcome were evaluated. Comparisons between survivors and non-survivors were performed using the Mann–Whitney U test, Pearson’s chi-square test, or Fisher’s exact test, as appropriate. Factors associated with in-hospital mortality were investigated using univariable and multivariable logistic regression. Results: Overall, 161/192 patients (83.9%) died during hospitalization. Non-survivors were significantly older than survivors [median: 71 (IQR: 62–78) vs. 62 (50.5–72) years; p = 0.025]. MDR organisms were more common among non-survivors (51.6% vs. 22.6%; p = 0.003), and MDR phenotype was associated with increased odds of mortality in univariable analysis (OR = 3.65, 95% CI: 1.49–8.95; p = 0.005). After adjustment for age, mechanical ventilation, and recent surgery, MDR remained independently associated with in-hospital mortality (aOR = 3.58, 95% CI: 1.42–8.98; p = 0.007). In the treatment-focused model, aminopenicillin exposure (aOR = 0.21, 95% CI: 0.07–0.64; p = 0.006), second-generation aminoglycosides (aOR = 0.23, 95% CI: 0.06–0.97; p = 0.045), and third-generation cephalosporins (aOR = 0.35, 95% CI: 0.14–0.88; p = 0.025) were associated with lower odds of mortality. No significant association was observed between time to specific antimicrobial therapy and mortality (p = 0.541). Conclusions: MDR was the main antimicrobial-resistance factor independently associated with in-hospital mortality among patients with HAIs. Although several antimicrobial classes were associated with lower odds of death, these observational associations should not be interpreted as causal treatment effects. The findings emphasize the importance of antimicrobial resistance surveillance, rapid microbiological diagnosis, antimicrobial stewardship, and timely access to active antimicrobial therapy.