A one-year prospective study of colonization with antimicrobial-resistant organisms on admission to a Vietnamese intensive care unit

Abstract

There is a paucity of data regarding initial bacterial colonization on admission to Intensive Care Units (ICUs) in low and middle-income countries (LMICs). Patients admitted to ICUs in LMICs are at high-risk of subsequent infection with antimicrobial-resistant organisms (AROs). We conducted a prospective, observational study at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam from November 2014 to January 2016 to assess the colonization and antimicrobial susceptibility of Staphylococcus aureus, Escherichia coli, Klebsiella spp., Pseudomonas spp. and Acinetobacter spp. among adult patients within 48 hours of ICU admission. We found the admission colonization prevalence (with at least one of the identified organisms) was 93.7% (785/838) and that of AROs was 63.1% (529/838). The colonization frequency with AROs among patients admitted from the community was comparable to those transferred from other hospitals (62.2% vs 63.8%). Staphylococcus aureus was the most commonly isolated bacteria from nasal swabs (13.1%, 110/838) and the methicillin-resistant Staphylococcus aureus nasal colonization prevalence was 8.6% (72/838). We isolated Escherichia coli from rectal swabs from almost all enrolled patients (88.3%, 740/838) and 52.1% (437/838) of patients were colonized by extended spectrum β-lactamase producing Escherichia coli. Notably, Klebsiella pneumoniae was the most frequently isolated bacteria from the tracheal swabs (11.8%, 18/153). Vietnamese ICU patients have a high rate of colonization with AROs and are thus at risk of subsequent infections with these organisms if good infection control practices are not in place.

Hospital-acquired colonization and infections in a Vietnamese intensive care unit

“…coli , Klebsiella spp., Pseudomonas spp. and Acinetobacter spp.. Staphylococcal colonies were checked for catalase and coagulase, plus checked for methicillin resistance using cefoxitin disc diffusion, and re-checked on the matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOF, Bruker) [ 14 ].…”

“…In LMICs, such as Vietnam, there is a large amount of antimicrobial use in the community [ 12 , 13 ]. In our previous publication, we found that up to 63.1% (529/838) patients colonized with AROs on ICU admission [ 14 ]. Due to a paucity of antimicrobial stewardship programs, the situation of colonization, infection and antimicrobial resistance may be different and more serious in our country.…”

Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries

“…We conducted a secondary analysis of 9 data sets: 8 cohort studies (5 prospective and 3 retrospective) and 1 randomized clinical trial. [8][9][10][11][12][13][14][15] Of the countries represented in this study (Bangladesh, Haiti, India, Indonesia, Myanmar, Rwanda, Sierra Leone, Sri Lanka, Thailand, and Vietnam), 3 are classified as low income, 6 as lower middle income, and 1 as upper middle income by the World Bank. 16 Patients were recruited to the cohorts from a range of hospital settings, including small community hospitals, military hospitals, rural regional hospitals, national referral hospitals, and specialty infectious disease hospitals.…”

Intestinal carriage of antibiotic resistant Acinetobacter baumannii among newborns hospitalized in Moroccan neonatal intensive care unit

“…Recent study in Taiwan, found just 0.2% of A . baumannii intestinal carriage from ICU admitted patients [18]. Furthermore, mouth/throat, skin and rectal swabs samples in a Turkish ICU revealed that 6.3% of adults hospitalised were colonized by A .…”