Hidden burden: healthcare-associated infections in long-term care facilities in an ageing Polish population: a 20-month prospective observational study.

Healthcare-associated infections (HAIs) in long-term care facilities (LTCFs) are a growing concern in ageing populations, particularly in Poland, where long-term care services face important workforce and organisational challenges. This prospective observational study assessed the clinical and epidemiological features of HAIs over 20 months (September 2022 - May 2024) in five LTCFs, including 250 residents. Using ECDC HALT-4 criteria, 194 HAIs were identified across 137,537 person-days (incidence 1.41/1000 pds). Respiratory tract infections (RTIs) were most common (n = 80 cases in 70 patients), followed by urinary tract infections (n = 41). The overall case-fatality rate was 8.25%, rising to 15.7% for RTIs. Antibiotics were prescribed 210 times, with β-lactams used most frequently, and total antimicrobial consumption reached 10.70 days of therapy per 1000 pds. RTIs accounted for nearly half of antibiotic use (46.4%) and were associated with older age, frailty, reduced functional status, and lack of pneumococcal vaccination. Clostridioides difficile infection incidence was low (0.6/10,000 pds), although many gastrointestinal infections lacked identified causes. Frailty and functional dependence were associated with RTI occurrence in separate multivariable models, although the frailty estimate was based on a substantially smaller complete-case sample and should be interpreted cautiously.