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PLoS One. 2016 Jan 29;11(1):e0147544. doi: 10.1371/journal.pone.0147544. eCollection 2016.

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

Author information

1
Intensive Care Unit, National Hospital for Tropical Diseases, Ha Noi, Vietnam.
2
Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam.
3
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.
4
Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
5
Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
6
Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
7
Intensive Care Unit, Bach Mai Hospital, Ha Noi, Vietnam.
8
Board of Directors, Viet Duc Hospital, Ha Noi, Vietnam.
9
Pharmacy, Saint-Paul Hospital, Ha Noi, Vietnam.
10
Intensive Care Unit, Viet Tiep Hospital, Hai Phong, Vietnam.
11
Board of Directors, Vietnam-Sweden Uong Bi Hospital, Quang Ninh, Vietnam.
12
Department of General Internal Medicine & Geriatric, Hue Central General Hospital, Hue, Vietnam.
13
Board of Directors, Da Nang Hospital, Da Nang, Vietnam.
14
Infectious Department, Binh Dinh Hospital, Binh Dinh, Vietnam.
15
Intensive Care Unit, Khanh Hoa Hospital, Khanh Hoa, Vietnam.
16
Planning Department, Dak Lak Hospital, Dak Lak, Vietnam.
17
Board of Directors, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
18
Board of Directors, Can Tho Central General Hosptial, Can Tho, Vietnam.
19
Board of directors, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
20
Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
21
Board of Directors, National Hospital for Tropical Diseases, Ha Noi, Vietnam.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

PMID:
26824228
PMCID:
PMC4732823
DOI:
10.1371/journal.pone.0147544
[Indexed for MEDLINE]
Free PMC Article

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