Need for improved antimicrobial and infection control stewardship in Vietnamese intensive care units

Johansson, Malin; Phuong, Doan Mai; Walther, Sten; Hanberger, Håkan

doi:10.1111/j.1365-3156.2011.02753.x

Cited by 21 publications

(19 citation statements)

References 19 publications

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“…Several hospitals have poor availability of water, soap and wipes. A recent study in ICUs showed hygiene precautions to be poor with fewer than 50% of patient contacts incorporating appropriate hand hygiene [47]. …”

Section: Resultsmentioning

confidence: 99%

Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam

et al. 2013

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BackgroundAntimicrobial resistance is a major contemporary public health threat. Strategies to contain antimicrobial resistance have been comprehensively set forth, however in developing countries where the need for effective antimicrobials is greatest implementation has proved problematic. A better understanding of patterns and determinants of antibiotic use and resistance in emerging economies may permit more appropriately targeted interventions.Viet Nam, with a large population, high burden of infectious disease and relatively unrestricted access to medication, is an excellent case study of the difficulties faced by emerging economies in controlling antimicrobial resistance.MethodsOur working group conducted a situation analysis of the current patterns and determinants of antibiotic use and resistance in Viet Nam. International publications and local reports published between 1-1-1990 and 31-8-2012 were reviewed. All stakeholders analyzed the findings at a policy workshop and feasible recommendations were suggested to improve antibiotic use in Viet Nam.Here we report the results of our situation analysis focusing on: the healthcare system, drug regulation and supply; antibiotic resistance and infection control; and agricultural antibiotic use.ResultsMarket reforms have improved healthcare access in Viet Nam and contributed to better health outcomes. However, increased accessibility has been accompanied by injudicious antibiotic use in hospitals and the community, with predictable escalation in bacterial resistance. Prescribing practices are poor and self-medication is common – often being the most affordable way to access healthcare. Many policies exist to regulate antibiotic use but enforcement is insufficient or lacking.Pneumococcal penicillin-resistance rates are the highest in Asia and carbapenem-resistant bacteria (notably NDM-1) have recently emerged. Hospital acquired infections, predominantly with multi-drug resistant Gram-negative organisms, place additional strain on limited resources. Widespread agricultural antibiotic use further propagates antimicrobial resistance.ConclusionsFuture legislation regarding antibiotic access must alter incentives for purchasers and providers and ensure effective enforcement. The Ministry of Health recently initiated a national action plan and approved a multicenter health improvement project to strengthen national capacity for antimicrobial stewardship in Viet Nam. This analysis provided important input to these initiatives. Our methodologies and findings may be of use to others across the world tackling the growing threat of antibiotic resistance.

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Section: Resultsmentioning

confidence: 99%

Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam

et al. 2013

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“…The prevalence of CRE, including CP-CRE, is high in the tertiary hospitals of the larger South Asian countries (10, 53, 62-71, 75, 82, 83, 99, 101, 102) but much lower in similar hospitals in Southeast Asia (74,114,120,121,129,134,142,147,149,150,157,161). As seen by the numerous reports of CP-CRE exportation from South and Southeast Asia (6,174,(176)(177)(178)(179)(180)(181)(182)(183)(184), international dissemination of CP-CRE appears to be a far greater problem than that of CRAB, and it will conceivably be more difficult for other countries to control CP-CRE within their own borders if this is also not tackled at its root in South and Southeast Asia.…”

Section: Discussionmentioning

confidence: 99%

“…The few reports highlighting CRE prevalence in Vietnamese institutions are summarized in Table 5. The multicenter ICU study conducted between 2012 and 2013 showed that 15% of K. pneumoniae isolates were resistant to the carbapenems (142), which was much higher than the 3% found in the earlier 2007 ICU study (147). Up to 1.1% of Enterobacteriaceae isolated between 2010 and 2012 were found to be CRE in a surgical hospital in Hanoi (149).…”

Section: Vietnam There Is No National or Regional Antimicrobial Resimentioning

confidence: 94%

“…The results from recent reports (published from 2010) are summarized in Table 5. The prevalence of CRAB in Vietnamese hospitals is very high, ranging from 43% in a pediatric hospital in Ho Chi Minh City to 92% in a tertiary referral hospital in Hanoi (142)(143)(144)(145)(146)(147). Unfortunately, the bulk of the studies were based on ICUs, where carbapenem resistance rates are usually higher (142)(143)(144)147).…”

Section: Vietnam There Is No National or Regional Antimicrobial Resimentioning

confidence: 99%

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Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia

et al. 2017

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SUMMARY Carbapenem-resistant Gram-negative bacteria, in particular the Acinetobacter baumannii-calcoaceticus complex and Enterobacteriaceae, are escalating global public health threats. We review the epidemiology and prevalence of these carbapenem-resistant Gram-negative bacteria among countries in South and Southeast Asia, where the rates of resistance are some of the highest in the world. These countries house more than a third of the world's population, and several are also major medical tourism destinations. There are significant data gaps, and the almost universal lack of comprehensive surveillance programs that include molecular epidemiologic testing has made it difficult to understand the origins and extent of the problem in depth. A complex combination of factors such as inappropriate prescription of antibiotics, overstretched health systems, and international travel (including the phenomenon of medical tourism) probably led to the rapid rise and spread of these bacteria in hospitals in South and Southeast Asia. In India, Pakistan, and Vietnam, carbapenem-resistant Enterobacteriaceae have also been found in the environment and community, likely as a consequence of poor environmental hygiene and sanitation. Considerable political will and effort, including from countries outside these regions, are vital in order to reduce the prevalence of such bacteria in South and Southeast Asia and prevent their global spread.

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“…In a European multi-centre cross-sectional prevalence study of academic ICUs, there were 14% of Klebsiella ESBL-producers, and nearly 25% of Pseudomonas aeruginosa isolates were carbapenemresistant [10] . ICUs in emerging economies report notably higher prevalence of ESBL-producers [11][12][13] and carbapenemresistant organisms [11][12][13][14] . Of note, the majority of multi-resistant Acinetobacter (MRA) isolates in these studies also demonstrates reduced susceptibility towards carbapenems [11][12][13] .…”

Section: Antibiotic Resistance In Icu Its Contributors and Impactmentioning

confidence: 99%

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Zhang

Singh

2015

WJCCM

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Antibiotic usage and increasing antimicrobial resistance (AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units (ICU). Antibiotic stewardship programmes (ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies" through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial (RCT), 22 observational and 11 case series], 29 (85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin (PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop (de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.

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Need for improved antimicrobial and infection control stewardship in Vietnamese intensive care units

Cited by 21 publications

References 19 publications

Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam

Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam

Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

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