Microbiology of surgical site infections and associated antimicrobial use among Vietnamese orthopedic and neurosurgical patients.
OBJECTIVE
To determine the pathogens associated with surgical site infections (SSIs) and describe patterns of antimicrobial use and resistance in orthopedic and neurosurgical patients in a large university hospital in Vietnam.


METHODS
Prospective cohort study.


METHODS
Cho Ray Hospital, Ho Chi Minh City, Vietnam.


METHODS
All patients who had operations during a 5-week study period.


RESULTS
Of 702 surgical patients, 80 (11.4%) developed an SSI. The incidence of SSI among orthopedic patients was 15.2% (48 of 315), and among neurosurgical patients it was 8.3% (32 of 387). Postoperative bacterial cultures of samples from the surgical sites were performed for 55 (68.8%) of the 80 patients with SSI; 68 wound swab specimens and 10 cerebrospinal fluid samples were cultured. Of these 78 cultures, 60 (76.9%) were positive for a pathogen, and 15 (25%) of those 60 cultures yielded multiple pathogens. The 3 most frequently isolated pathogens were Pseudomonas aeruginosa (29.5% of isolates), Staphylococcus aureus (11.5% of isolates), and Escherichia coli (10.3% of isolates). Ninety percent of S. aureus isolates were methicillin resistant, 91% of P. aeruginosa isolates were ceftazidime resistant, and 38% of E. coli isolates were cefotaxime resistant. All but 1 of the 702 patients received antimicrobial therapy after surgery, and the median duration of antimicrobial therapy was 11 days. Commonly used antimicrobials included aminopenicillins and second- and third-generation cephalosporins. Two or more agents were given to 634 (90%) of the patients, and most combination drug regimens (86%) included an aminoglycoside.


CONCLUSIONS
Our data indicate that the incidence of SSI is high in our study population, that the main pathogens causing SSI are gram-negative bacteria and are often resistant to commonly used antimicrobials, that the use of broad-spectrum antimicrobials after surgery is widespread, and that implementation of interventions aimed at promoting appropriate and evidence-based use of antimicrobials are needed in Vietnam.
Le
Thi Anh Thu
TA
Infection Control Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam. athu@hcmc.netnam.vn
Sohn
Annette H
AH
Nguyen
Phuc Tien
PT
Vo
Thi Chi Mai
TC
Vo
Van Nho
VN
Tran Nguyen
Trinh Hanh
TH
Ewald
Ben
B
Dibley
Michael
M
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D014744:Vietnam
D000890:Anti-Infective Agents