Aslı VATAN, Seda KABUKÇU, Oğuz KARABAY, Ertuğrul GÜÇLÜ, Aziz ÖĞÜTLÜ
Cerrahpaşa Medical Journal - 2026;50(1):1-7
Objective: The COVID-19 pandemic led to substantial structural changes in intensive care unit (ICU) organization worldwide. However, data on long-term changes in healthcare-associated infection (HAI) epidemiology after COVID-19-related ICU reorganization remain limited. This study compared HAI epidemiology before and after COVID-19-related ICU reorganization while excluding the pandemic transition period. Methods: This retrospective surveillance study included HAI episodes among adult patients admitted to level II and III ICUs of a 600-bed tertiary teaching and research hospital between January 2015 and June 2025. Healthcare-associated infection episodes diagnosed during the pandemic transition period (March 2020-June 2021) were excluded. The pre-COVID period (January 2015-March 2020) was compared with the post-reorganization period (July 2021-June 2025). Healthcare-associated infections were identified using Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance definitions applicable during each surveillance year. Patient-level characteristics, episode-level infection types and microbiological findings, device-associated infection rates, and in-hospital mortality were compared. Results: A total of 3015 HAI episodes occurring in 2351 patients were included: 1062 episodes in 828 patients during the pre-COVID period and 1953 episodes in 1523 patients during the post-reorganization period. The overall HAI rate increased significantly from 5.64% to 6.42% (rate ratio [RR], 1.14; 95% CI, 1.06-1.23; P < .001). Device-associated infection rates also increased significantly , including catheter-associated urinary tract infection (RR, 1.31; P = .011), ventilator-associated pneumonia (RR, 3.03; P < .001), and central line-associated bloodstream infection (RR, 1.52; P < .001). The post-reorganization period showed higher proportions of ventilator-associated pneumonia and non-ventilator-associated pneumonia, predominance of gram-negative pathogens, increased frequencies of Acinetobacter spp. and Pseudomonas spp., emergence of Candida auris, and higher in-hospital mortality (69.1% vs. 54.3%; P < .001). Conclusion: Healthcare-associated infection epidemiology differed substantially between the pre-COVID and post-reorganization periods. Increased device-associated infection rates, shifts in pathogen distribution, emergence of Candida auris, and higher in-hospital mortality highlight the need for sustained infection prevention and control efforts beyond the pandemic period.
