Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units

Vietnam is a lower middle-income country with no national surveillance system for hospital-acquired infections (HAIs). We assessed the prevalence of hospital-acquired infections and antimicrobial use in adult intensive care units (ICUs) across Vietnam. Monthly repeated point prevalence surveys were...

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Published in:	PloS one Vol. 11; no. 1; p. e0147544
Main Authors:	Phu, Vu Dinh, Wertheim, Heiman F L, Larsson, Mattias, Nadjm, Behzad, Dinh, Quynh-Dao, Nilsson, Lennart E, Rydell, Ulf, Le, Tuyet Thi Diem, Trinh, Son Hong, Pham, Hung Minh, Tran, Cang Thanh, Doan, Hanh Thi Hong, Tran, Nguyen Thua, Le, Nhan Duc, Huynh, Nhuan Van, Tran, Thao Phuong, Tran, Bao Duc, Nguyen, Son Truong, Pham, Thao Thi Ngoc, Dang, Tam Quang, Nguyen, Chau Van Vinh, Lam, Yen Minh, Thwaites, Guy, Van Nguyen, Kinh, Hanberger, Hakan
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 29-01-2016 Public Library of Science (PLoS)
Subjects:	Acinetobacter baumannii - isolation & purification Adult Adults Aged Aged, 80 and over Alcohol Anti-Bacterial Agents - therapeutic use Anti-infective agents Antiinfectives and antibacterials Antimicrobial agents Bacteria Biology and Life Sciences Boards of directors Carbapenems Cephalosporins Clinical medicine Cross infection Cross Infection - drug therapy Cross Infection - epidemiology Demographic aspects Disease control Disease prevention Drug resistance Drug Resistance, Bacterial Enterobacteriaceae Female Fluoroquinolones Gram-negative bacteria Hospitals Humans Infection Control Infections Infectious diseases Intensive care Intensive Care Units Intubation Klebsiella Klebsiella pneumoniae - isolation & purification Male Medical instruments Medicin och hälsovetenskap Medicine Medicine and Health Sciences Middle Aged Multivariate analysis Nosocomial infections Patients Pneumonia Polls & surveys Prevalence Pseudomonas aeruginosa Pseudomonas aeruginosa - isolation & purification Risk analysis Risk factors Surgery Surveillance Tropical diseases Urinary tract infections Ventilators Vietnam - epidemiology Vietnam Sweden United Kingdom > UK United States > US Europe
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Summary:	Vietnam is a lower middle-income country with no national surveillance system for hospital-acquired infections (HAIs). We assessed the prevalence of hospital-acquired infections and antimicrobial use in adult intensive care units (ICUs) across Vietnam. Monthly repeated point prevalence surveys were systematically conducted to assess HAI prevalence and antimicrobial use in 15 adult ICUs across Vietnam. Adults admitted to participating ICUs before 08:00 a.m. on the survey day were included. Among 3287 patients enrolled, the HAI prevalence was 29.5% (965/3266 patients, 21 missing). Pneumonia accounted for 79.4% (804/1012) of HAIs Most HAIs (84.5% [855/1012]) were acquired in the survey hospital with 42.5% (363/855) acquired prior to ICU admission and 57.5% (492/855) developed during ICU admission. In multivariate analysis, the strongest risk factors for HAI acquired in ICU were: intubation (OR 2.76), urinary catheter (OR 2.12), no involvement of a family member in patient care (OR 1.94), and surgery after admission (OR 1.66). 726 bacterial isolates were cultured from 622/1012 HAIs, most frequently Acinetobacter baumannii (177/726 [24.4%]), Pseudomonas aeruginosa (100/726 [13.8%]), and Klebsiella pneumoniae (84/726 [11.6%]), with carbapenem resistance rates of 89.2%, 55.7%, and 14.9% respectively. Antimicrobials were prescribed for 84.8% (2787/3287) patients, with 73.7% of patients receiving two or more. The most common antimicrobial groups were third generation cephalosporins, fluoroquinolones, and carbapenems (20.1%, 19.4%, and 14.1% of total antimicrobials, respectively). A high prevalence of HAIs was observed, mainly caused by Gram-negative bacteria with high carbapenem resistance rates. This in combination with a high rate of antimicrobial use illustrates the urgent need to improve rational antimicrobial use and infection control efforts.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Conceived and designed the experiments: VDP HFLW ML LEN UR HH KVN. Performed the experiments: VDP HFLW ML BN QDD LEN UR TTDL SHT HMP CTT HTHD NTT NDL NVH TPT BDT STN TTNP TQD CVVN YML GT KVN HH. Analyzed the data: VDP HFLW BN QDD HH. Wrote the paper: VDP HFLW BN ML LEN UR HH KVN GT. Current address: Department of medical microbiology, Radboudumc, Nijmegen, Netherlands. Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0147544