Nosocomial infections and misuse of antibiotics in a provincial community hospital, Saudi Arabia.

The incidence of nosocomial infection and prevalence of antibiotic misuse were studied in a 174-bed community hospital in Saudi Arabia over a six-month period. Of 2445 patients admitted, 8.5% developed nosocomial infection, the rates were highest for nursery (35.8%), intensive care (19.8%), gynaecological (16.2%) and surgical (11.7%) patients. Urinary tract (31.3%), wound (27.1%) and blood (14.9%) infections accounted for more than 70% of the infections. Staphylococcus aureus (23%) and Pseudomonas aeruginosa (11%), caused more than 90% of the infections. The majority of the bacterial pathogens (79%) were multi-drug resistant. Over 80% of patients were administered prophylactic and/or therapeutic antibiotics, with 53% receiving multiple antibiotics; 72% of the antibiotics were judged to be misused. Both prophylaxis and treatment were mostly misguided and clinically unwarranted. Host- and hospital-associated infection risk factors were identified. The minimum government cost estimates for the nosocomial infections and misused antibiotics were US $273 180 and $565 603, respectively. The findings emphasize the need for effective measures to reduce both the high infection rates and widespread antibiotic misusage in the hospital. Such measures should include institution of an effective infection control committee and a hospital antibiotic policy.