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

Abstract

Data concerning intensive care unit (ICU)-acquired bacterial colonization and infections are scarce from low and middle-income countries (LMICs). ICU patients in these settings are at high risk of becoming colonized and infected with antimicrobial-resistant organisms (AROs). We conducted a prospective observational study at the Ho Chi Minh City Hospital for Tropical Diseases, Vietnam from November 2014 to January 2016 to assess the ICU-acquired colonization and infections, focusing on the five major pathogens in our setting: Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Klebsiella spp., Pseudomonas spp. and Acinetobacter spp., among adult patients with more than 48 hours of ICU stay. We found that 61.3% (223/364) of ICU patients became colonized with AROs: 44.2% (161/364) with rectal ESBL-producing E. coli and Klebsiella spp.; 30.8% (40/130) with endotracheal carbapenemase-producing Acinetobacter spp.; and 14.3% (52/364) with nasal methicillin-resistant S. aureus. The incidence rate of ICU patients becoming colonized with AROs was 9.8 (223/2,276) per 100 patient days. Significant risk factor for AROs colonization was the Charlson Comorbidity Index score. The proportion of ICU patients with HAIs was 23.4% (85/364), and the incidence rate of ICU patients contracting HAIs was 2.3 (85/3,701) per 100 patient days. The vascular catheterization (central venous, arterial and hemofiltration catheter) was significantly associated with hospital-acquired bloodstream infection. Of the 77 patients who developed ICU-acquired infections with one of the five specified bacteria, 44 (57.1%) had prior colonization with the same organism. Vietnamese ICU patients have a high colonization rate with AROs and a high risk of subsequent infections. Future research should focus on monitoring colonization and the development of preventive measures that may halt spread of AROs in ICU settings.

First Report on Multidrug-Resistant Methicillin-Resistant Staphylococcus aureus Isolates in Children Admitted to Tertiary Hospitals in Vietnam

“…The decreased susceptibility of S. aureus to VAN has been reported since 1997 [26]. Our study showed that VAN was fully sensitive to MRSA, which was consistent with previous reports from many Asian countries (Vietnam, Hong Kong, Philippines, Sri Lanka, Korea, China, Thailand, Nepal, Taiwan, and India) [8,9,22,25,27,28], whereas its high doses have been recommended to maintain efficacy in other countries [29]. VAN-sensitive MRSA was reported in eight pediatric hospitals in mainland China [19], whereas reduced VAN susceptibility was found in MRSA and methicillin-sensitive S. aureus clinical strains in two adult hospitals in northeast China [30].…”

Multi-drug resistance and nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot Referral Hospital, Northwest Ethiopia: A cross-sectional study

“…This was coherent with studies in Sodo, Ethiopia (41.7%) [15], Southeast China (36.6%) [33], India (54%) [42] and Vietnam (40%) [43]. However, higher level of resistance against meropenem was documented in Taiwan (73.2%) [45], Pakistan (86.4%) [35] and Saudi (81.8%) [46].The relatively lower proportion resistance against meropenem in the present study might be due to the absence of meropenem prescription practice for patients in the study hospital.…”

“…In this study, all isolates of P. aeruginosa revealed 100% resistance against piperacillin. This was significantly higher than studies from Italy (25%) [25], Vietnam (17.7%) [43], Southeast China (12%) [33], Turkey (28.7%) [44] and Taiwan (66.8%) [45].This might be associated with differences in the number of MDR strains of P.aeruginosa and patient type. The frustrating level of resistance against piperacillin antibiotic is an alarm for treatment to be guided with antimicrobial susceptibility testing hence so far, piperacillin was not prescribed in the study area (FHRH).…”

“…Moreover, 70.8% and 92.8% level of resistance against cefotaxime documented in Sodo, Ethiopia [15] and Southeast China [33], respectively. On the other hand, low level of resistance against ceftazidime reported in Tikur Anbessa Hospital (12.5%) and Sodo, Ethiopia (29.1%) [15,22], Italy (31%) [25] and Vietnam (22.1%) [43]. The highest level of resistance against third generation cephalosporins might be linked with excessive use, mis and inappropriate use of these antibiotics in the study hospital that drives selective pressure and emergence of MDR.…”

Enhancing appropriate environmental design in healthcare facilities for the inhibition of nosocomial infection

“…A vector is an organism that does not cause disease itself but that transmits infection by conveying pathogens from one host to another [15]. Vectors may be mechanical or biological.…”