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Decade-Long Declines in Healthcare-Associated and Device-Associated Infections in a High-Volume Liver Transplant
Adem Kose1, Leyla Erdemci1, Seyma Yasar2
1Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey.
Background:
Healthcare-associated infections (HAIs) remain a major cause of morbidity and healthcare burden in liver transplant recipients. However, long-term surveillance data from dedicated liver transplant intensive care units (ICUs) are limited. This study evaluated decade-long trends in healthcare-associated and device-associated infections in a high-volume liver transplant ICU undergoing substantial expansion.
Methods:
This retrospective observational study analyzed prospectively collected surveillance data from the Liver Transplant ICU of Inonu University between January 2015 and December 2024. Overall, HAI incidence rates were calculated per 1000 patient-days, while ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central line-associated bloodstream infection (CLABSI) rates were calculated per 1000 device-days. Temporal trends were assessed using Poisson regression analysis.
Results:
A total of 7717 adult liver transplant recipients accounting for 48,001 patient-days were included. During the study period, ICU capacity increased from 12 to 36 beds and annual patient volume increased from 612 to 961 admissions. Overall, 285 HAI episodes were recorded. HAI incidence decreased from 14.37 to 2.98 per 1000 patient-days, representing a 79.3% reduction. Poisson regression demonstrated a significant annual decline in HAI incidence (incidence rate ratio[IRR], 0.85; 95% confidence interval [CI], 0.82-0.89; P < .001). Significant reductions were also observed for VAP (IRR, 0.86; P = .003), CAUTI (IRR, 0.78; P < .001), and CLABSI (IRR, 0.84; P < .001). Device utilization ratios remained relatively stable throughout the study period.
Conclusions:
Marked reductions in healthcare-associated and device-associated infections were achieved despite stable device utilization, increasing patient volume, and a threefold expansion in ICU capacity. Importantly, infection rates continued to decline throughout this period, suggesting that institutional growth need not compromise infection control performance when supported by robust surveillance and continuously reinforced prevention strategies.
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