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

• 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
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0147544

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.