PLoS ONE (Jan 2016)

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

  • Vu Dinh Phu,
  • Heiman F L Wertheim,
  • Mattias Larsson,
  • Behzad Nadjm,
  • Quynh-Dao Dinh,
  • Lennart E Nilsson,
  • Ulf Rydell,
  • Tuyet Thi Diem Le,
  • Son Hong Trinh,
  • Hung Minh Pham,
  • Cang Thanh Tran,
  • Hanh Thi Hong Doan,
  • Nguyen Thua Tran,
  • Nhan Duc Le,
  • Nhuan Van Huynh,
  • Thao Phuong Tran,
  • Bao Duc Tran,
  • Son Truong Nguyen,
  • Thao Thi Ngoc Pham,
  • Tam Quang Dang,
  • Chau Van Vinh Nguyen,
  • Yen Minh Lam,
  • Guy Thwaites,
  • Kinh Van Nguyen,
  • Hakan Hanberger

DOI
https://doi.org/10.1371/journal.pone.0147544
Journal volume & issue
Vol. 11, no. 1
p. e0147544

Abstract

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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.