Prevalence of Healthcare‐Acquired Infections Among Adults in Intensive Care Units: A Systematic Review and Meta‐Analysis

Abstract

Background and Aim: Healthcare‐acquired infections (HAIs) are a major cause of morbidity and mortality among critically ill adult patients admitted to intensive care units (ICUs) with underlying health conditions. Precisely estimating the burden of HAIs in adult ICUs is important for guiding prevention efforts and assessing the impact of intervention programs. This review aims to synthesize the available epidemiological data on the prevalence of different HAI types in adult ICUs. Methods: A systematic search was conducted via the PubMed, Scopus, and Web of Science databases to identify prevalence studies of HAIs published up to August 14, 2024, involving adult ICU patients. Pooled prevalence estimates and 95% confidence intervals were calculated using random effects models. Heterogeneity was assessed using the I2 statistic. Results: A total of 21 studies involving 15,966 patients with 4288 adult ICU HAI cases were included in the meta‐analysis. Pneumonia, whether ventilator‐associated (VAP) or non‐VAP, demonstrated the highest prevalence. The pooled all‐cause pneumonia and VAP prevalence were 51.0% (95% CI 40.0–63.0%, I2=98%, p<0.01) and 54.0% (95% CI 31.0–76.0%, I2=98%, p<0.01), respectively. The prevalence of bloodstream infections was 34.0% (95% CI 25.0–42.0%, I2=98%, p<0.01), whereas those of urinary tract infections and surgical site infections were 26.0% (95% CI 17.0–35.0%, I2= 98%, p<0.01) and 12.0% (95% CI 7.0–17.0%, I2=92%, p<0.01), respectively. Patient risk factors included chronic kidney disease (52%), malignancy (45%), immunosuppression (40%), and diabetes (35%). No significant differences in risk between sexes emerged. Invasive procedures, especially tracheostomy (74%), carried the highest risk. Conclusion: This review revealed that BSIs, UTIs, pneumonia, and VAP constitute the most common HAIs in adults. Invasive devices, surgery, antimicrobial exposure, and underlying patient health conditions increase the risk. Targeting reductions in device usage durations and optimizing antibiotic stewardship may help lower infection rates in intensive care units.