{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T16:34:21Z","timestamp":1772210061854,"version":"3.50.1"},"reference-count":30,"publisher":"The Korean Society of Critical Care Medicine","issue":"4","license":[{"start":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T00:00:00Z","timestamp":1701129600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["accjournal.org"],"crossmark-restriction":true},"short-container-title":["ACC"],"published-print":{"date-parts":[[2023,11,30]]},"abstract":"<jats:p>healthBackground:Coronavirus disease 2019 (COVID-19) pandemic disrupted adherences to healthcare-associated infection (HAI) prevention protocols. Herein, we studied the characteristics of all HAIs occurring in critically ill COVID-19 patients.Methods: A retrospective, single-center cohort of critical COVID-19 patients during 2021. Microbiological samples were collected if HAI was suspected. We analyzed all factors that could potentially induce HAI, using septic shock and mortality as endpoints.Results: Sixty-four among 161 included patients (39.7%) presented a total of 117 HAIs with an incidence density of 69.2 per 1,000 hospitalization days. Compared to the prior COVID-19 period (2013\u20132019), the identification of HAI increased in 2021. HAIs were classified into ventilator-associated pneumonia (VAP; n=38), bloodstream infection (n=32), urinary tract infection (n=24), catheter-related infection (n=12), and fungal infection (n=11). All HAIs occurred significantly earlier in the post\u2013COVID-19 period (VAP: 6 vs. 10 days, P=0.045, in 2017 and 2021). Acinetobacter baumannii (39.5%) and Klebsiella pneumoniae (27%) were the most commonly isolated pathogens that exhibited a multidrug-resistant (MDR) profile, observed in 89% and 64.5%, respectively. The HAI factors were laboratory abnormalities (odds ratio [OR], 6.4; 95% confidence interval [CI], 2.3\u201326.0), cumulative steroid dose (OR, 1.9; 95% CI, 1.3\u20134.0), and invasive procedures (OR, 20.7; 95% CI, 5.3\u201364.0). HAI was an independent factor of mortality (OR, 8.5; P=0.004).Conclusions: During the COVID-19 era, the incidence of HAIs increased and MDR isolates remained frequent. A severe biological inflammatory syndrome, invasive devices, and elevated cumulative steroid dosages were related to HAIs. HAI was a significant death factor.<\/jats:p>","DOI":"10.4266\/acc.2023.00773","type":"journal-article","created":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T04:57:20Z","timestamp":1701147440000},"page":"425-434","update-policy":"https:\/\/doi.org\/10.4266\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and 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