High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs

Le, Ngai Kien; Hf, Wertheim; Vu, Phu Dinh; Khu, Dung Thi Khanh; Le, Hai Thanh; Hoang, Bich Thi Ngoc; Vo, Vu T.A.; Lam, Yen Minh; Vu, Dung Tien Viet; Nguyen, Tien V.; Thai, Tung Quang; Nilsson, Lennart; Rydell, Ulf; Nguyen, Kinh Van; Nadjm, Behzad; Clarkson, Louise; Hanberger, Håkan; Larsson, Mattias

doi:10.1097/md.0000000000004099

Cited by 58 publications

(55 citation statements)

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“…The participating hospitals were largely recruited from the previous VINARES study network, with a geographic spread covering northern, central and southern Vietnam. 20,21…”

Section: Carbapenem-resistant Enterobacteriaceae Point Prevalence Stumentioning

confidence: 99%

“…HAI was defined according to the European Centre for Disease Control and Prevention (ECDC), as used in the previous VINARES study. 20,24…”

Section: Definitionsmentioning

confidence: 99%

“…20 In adult ICUs, Acinetobacter baumannii, Pseudomonas aeruginosa and K. pneumoniae had carbapenem-resistance rates of 89%, 56%, and 15%, respectively. 20 Whole-genome sequencing of carbapenem-resistant K. pneumoniae (CRKP), revealed a high prevalence of the carbapenemase KPC-2 and increasing colistin resistance due to chromosomal mutations 22 and the mcr-1 gene, 23 severely limiting treatment options for serious HAIs caused by K. pneumoniae. The high frequency of CRKP 20 initiated further surveillance of CRE colonisation to determine the dissemination at country, region, hospital and ward levels.…”

Section: Introductionmentioning

confidence: 99%

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High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease

Tran

Larsson

Olson

et al. 2019

Journal of Infection

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“…The participating hospitals were largely recruited from the previous VINARES study network, with a geographic spread covering northern, central and southern Vietnam. 20,21…”

Section: Carbapenem-resistant Enterobacteriaceae Point Prevalence Stumentioning

confidence: 99%

“…HAI was defined according to the European Centre for Disease Control and Prevention (ECDC), as used in the previous VINARES study. 20,24…”

Section: Definitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease

Tran

Larsson

Olson

et al. 2019

Journal of Infection

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“…20 , 21 Klebsiella pneumoniae (of which 55% were carbapenem-resistant) was the most common aetiology in paediatric ICUs. 20 In adult ICUs, Acinetobacter baumannii, Pseudomonas aeruginosa and K. pneumoniae had carbapenem-resistance rates of 89%, 56%, and 15%, respectively. 20 Whole-genome sequencing of carbapenem-resistant K. pneumoniae (CRKP), revealed a high prevalence of the carbapenemase KPC-2 and increasing colistin resistance due to chromosomal mutations 22 and the mcr-1 gene, 23 severely limiting treatment options for serious HAIs caused by K. pneumoniae.…”

Section: Introductionmentioning

confidence: 99%

High Prevalence of Colonisation with Carbapenem-Resistant Enterobacteriaceae Among Patients Admitted to Vietnamese Hospitals: Risk Factors and Burden of Disease

Tran

Larsson²,

Olson³

et al. 2019

SSRN Journal

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Background: Carbapenem-resistant Enterobacteriaceae (CRE) is an increasing problem worldwide, but particularly problematic in low-and middle-income countries (LMIC) due to limitations of resources for surveillance of CRE and infection prevention and control (IPC). Methods: A point prevalence survey (PPS) with screening for colonisation with CRE was conducted on 2233 patients admitted to neonatal, paediatric and adult care at 12 Vietnamese hospitals located in northern, central and southern Vietnam during 2017 and 2018. CRE colonisation was determined by culturing of faecal specimens on selective agar for CRE. Risk factors for CRE colonisation were evaluated. A CRE admission and discharge screening sub-study was conducted among one of the most vulnerable patient groups; infants treated at an 80-bed Neonatal ICU from March throughout June 2017 to assess CRE acquisition, hospital-acquired infection (HAI) and treatment outcome. Results: A total of 1165 (52%) patients were colonised with CRE, most commonly Klebsiella pneumoniae (n = 805), Escherichia coli (n = 682) and Enterobacter spp. (n = 61). Duration of hospital stay, HAI and treatment with a carbapenem were independent risk factors for CRE colonisation. The PPS showed that the prevalence of CRE colonisation increased on average 4.2% per day and mean CRE colonisation rates increased from 13% on the day of admission to 89% at day 15 of hospital stay. At the NICU, CRE colonisation increased from 32% at admission to 87% at discharge, mortality was significantly associated (OR 5 •5, P < 0 •01) with CRE colonisation and HAI on admission.

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“…Penelitian yang dilakukan di negara Amerika Serikat, Kanada dan Arab Saudi, menunjukkan bahwa terdapat tiga jenis obat yang paling sering digunakan di ruang NICU, dan dua di antaranya adalah antibiotik yaitu ampisilin dan gentamisin yang diberikan pada 1.691 bayi dan 1,667 bayi, secara berturut-turut. 20 Hasil dari sebuah kajian sistematis yang dilakukan dengan memanfaatkan sebanyak empat buah database 23 Munculnya resistensi terhadap golongan karbapenem menyebabkan semakin terbatasnya pilihan terapi yang dimiliki pasien dan beberapa di antaranya memiliki harga yang relatif mahal seperti tigecycline dan doripenem. [24][25][26] Tingginya penggunaan antibiotik dengan spektrum luas, walaupun sangat diperlukan, dapat memiliki dampak pada munculnya kasus infeksi oleh bakteri dengan extended spectrum beta-lactamase (ESBL) sebuah enzim yang dapat memotong cincin beta-laktam pada hampir seluruh antibiotik golongan betalaktam.…”

Section: Pembahasanunclassified

Kajian Penggunaan Antibiotik pada Neonatus Intensive Care Unit di Sebuah Rumah Sakit Pemerintah di Surabaya

Hidayat

Setiadi

Setiawan

2019

ijcp

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Penggunaan antibiotik menjadi salah satu terapi yang banyak diberikan pada bayi di Neonatal Intensive Care Unit (NICU). Penelitian ini ditujukan untuk mengetahui profil dan mengkaji biaya, ketepatan dan ketercampuran atau kompatibilitas penggunaan antibiotik pada pasien di NICU salah satu rumah sakit pemerintah di Surabaya dalam kurun waktu November–Desember 2015. Penelitian ini merupakan penelitian potong lintang yang dilakukan secara prospektif dengan memanfaatkan data rekam medis sebagai sumber data utama. Seluruh informasi yang diperoleh dari pasien NICU yang menggunakan antibiotik dan masuk dalam kriteria inklusi dan eksklusi dianalisis secara deskriptif. Total 32 orang pasien dilibatkan dalam penelitian ini. Penggunaan antibiotik terdiri dari 25 kali penggunaan antibiotik tunggal dan 14 kali penggunaan antibiotik kombinasi. Ampisilin merupakan antibiotik tunggal yang paling banyak digunakan, sedangkan penggunaan antibiotik kombinasi terbanyak adalah penggunaan kombinasi ampisilin dan gentamisin. Dari total seluruh pasien, hanya terdapat 13 pasien dengan diagnosis infeksi dan hanya 2 pasien (15,38%) yang mendapat terapi antibiotik yang tepat. Proses pergantian terapi didominasi oleh proses de-eskalasi yaitu sebesar 44,44%. Berdasarkan analisis kompatibilitas, terdapat banyak pencampuran sediaan antibiotik intravena yang tidak dapat diklasifikasikan compatible atau not compatible akibat tidak tersedianya informasi terkait kompatibilitasnya. Biaya penggunaan antibiotik yang harus dikeluarkan pasien rata-rata sebesar Rp265.252,00 (min–max= Rp16.100,00 s.d. Rp2.091.590,00). Ketepatan penggunaan antibiotik di ruang NICU perlu ditingkatkan sebagai upaya untuk meminimalkan risiko dampak negatif khususnya peningkatan biaya dan risiko resistensi.Kata kunci: Biaya antibiotik, kajian penggunaan antibiotik, kompatibilitas, neonatal intensive care unit Antibiotics Utilization Review in a Neonate Intensive Care Unit of a Public Hospital in SurabayaAbstractAntibiotic is frequently used in the Neonatal Intensive Care Unit (NICU). The aim of this study was to identify the usage pattern and to review the cost, appropriateness, and compatibility of antibiotics given to the patients in the NICU of one public hospital in Surabaya during November to December 2015. This was a cross-sectional study using medical record as the main source of the data. All information about eligible patients receiving antibiotics in the NICU was analysed descriptively. A total of 32 patients was involved in this study. The antibiotics utilization profile consisted of 25 single and 14 combination therapy. Ampicillin and ampicillin-gentamycin were found as the most frequently used in the single and combination therapy, consecutively. From all patients received antibiotics, 13 patients had confirmed with infections problem and only 2 patients (15.38%) received appropriate antibiotics therapy. From all therapeutic modification made, 44.44% was de-escalation. According to the compatibility analysis, lots of antibiotic intravenous admixtures in this research could not be clearly identified as compatible or not compatible because no information was available. The average cost of antibiotics per patient was IDR 265,252 (range IDR 16,100 to IDR 2,091,500). There is a need to optimize the use of antibiotics in the NICU in order to minimize the risk of adverse outcomes especially the increased cost and risk of resistance.Keywords: Antibiotics utilisation review, compatibility, cost of antibiotics, neonatal intensive care unit

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High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs

Abstract: Supplemental Digital Content is available in the text

Cited by 58 publications

References 26 publications

High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease

High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease

High Prevalence of Colonisation with Carbapenem-Resistant Enterobacteriaceae Among Patients Admitted to Vietnamese Hospitals: Risk Factors and Burden of Disease

Kajian Penggunaan Antibiotik pada Neonatus Intensive Care Unit di Sebuah Rumah Sakit Pemerintah di Surabaya

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