Nosocomial infections: a rebound in France, with a Covid effect

Yasmina Kattou with AFP 14:13 p.m., May 26, 2023

One in eighteen hospitalized patients in France is affected by at least one nosocomial infection: a rebound caused in part by Covid, according to a national survey of these infections contracted in a health facility, responsible for more than 4,000 deaths per year. After falling steadily between 2001 and 2012, then stagnating from 2012 to 2017, the proportion of infected patients increased between 2017 and 2022 (+14.7%), notes Public Health France (SpF) in a statement published Friday.

Compared to its European neighbours, the France is average (17th out of 31 countries in 2017 for nosocomial prevalence). It will be necessary to wait until 2024 for the finalization of the surveys conducted in Europe in 2022. Health authorities estimate that some 4,200 people die from nosocomial infections each year in France. The 2022 edition of this five-year Public Health survey France was conducted between May 15 and June 30, on a given day, among 1,155 health facilities (more than 150,000 patients).

Consequences of the Covid epidemic

The Covid epidemic has weighed in, directly or indirectly: "the proportion of infected patients is higher than five years ago, but nosocomial Covid infections represent half of the increase," Anne Berger-Carbonne, head of the Healthcare-associated infections and antibiotic resistance unit at SpF, told AFP. In his eyes, "it is a very broad photograph that is not so bad in the wake of the terrible Covid crisis. We expected worse."

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If we exclude nosocomial Covid, the proportion of infected patients in 2022 remains up (+7.5%) but "not significantly" compared to that estimated in 2017, according to the health agency. It observes that "compared to 2017, patients hospitalized in 2022 presented increased risks of infectious complications", due to more vulnerable profiles or the use of invasive care devices.

In 2022, hospital activity remained affected by the Covid pandemic but also by the "ambulatory shift" of the health system, "so that hospitalized people were in a more serious situation", in the eyes of Anne Berger-Carbonne. The shift to ambulatory care is accompanied by a shortening of hospital stays, and long stays are reserved for the most serious cases.

Four bacteria

Nosocomial infections are still more common in intensive care units (nearly one in four infected patients), which treat more vulnerable patients exposed to invasive devices (catheter, respiratory support, urinary catheter). Urinary tract infections, related to surgery, pneumonia, bacteremia (presence of bacteria in the blood) remain the main manifestations of the scourge. Four bacteria, including Escherichia coli and Staphylococcus aureus, are involved in nearly one in two cases of nosocomial infection in hospital, almost as in 2017.

Another takeaway from the survey: about one in six hospitalized patients receive antibiotic treatment, a proportion up 7.5% compared to 2017. "This is not a very good sign," says the public health specialist France. Antibiotic resistance – the fact that some bacteria eventually become resistant to antibiotics – is indeed considered a major threat by global health authorities. One in two patients is treated with antibiotics in intensive care, one in four in medical or surgical departments, according to the SpF survey.

However, the Covid context has been able to change priorities, with less effort on the measured use of antibiotics. And "antibiotic resistance prevention teams have not been spared by the crisis of caregivers," notes Anne Berger-Carbonne.

For the public health agency, these results "encourage to continue prevention actions" of nosocomial infections by targeting them on the most frequent (urinary tract infections, pneumonia, surgical site infections, bacteremia). It is also necessary to "strengthen actions for the proper use of antibiotics".