Hospital-acquired infections worldwide in relation to Gross Domestic Product: A global ecological analysis of point-prevalence surveys

Hospital-acquired infections (HAI) are a major public health problem worldwide. The World Health Organization estimates that 7% of patients could be affected by at least one HAI in high income countries (HICs), and 15% in low- and middle-income countries (LMICs).We hypothesized that countries with higher Groos Domestic Product (GDP) would have lower HAI prevalence rates, reflecting better investment in infection prevention and control programs.We therefore carried out an ecological study, based on published results from national or multicenter repeated prevalence surveys of HAI, to describe the relationship between GDP by country and the HAI prevalence rate. Economic resources per country were estimated using the GDP. Univariate correlation was calculated and presented graphically. The study included 94 HAI prevalence surveys conducted in 19 countries between 1984 and 2022. The majority of surveys (76.6%) were carried out in HICs. The number of surveys increased from 9 between 1984 and 1993–38 between 2014 and 2022. The weighted average proportion of patients with at least one HAI was 6.1%. We observed a decreasing trend in the weighted average proportion of patients with at least one HAI as GDP per capita increased (R = - 0.3997; P = 0.09).This ecological study provides insights into a potential association between national economic level and the burden of HAIs. To better investigate the impact of GDP on HAI prevalence, future research should incorporate a larger number of surveys with more balanced representation across geographic regions and income levels.