title: Microbiology of surgical site infections and associated antimicrobial use among Vietnamese orthopedic and neurosurgical patients.
abstract: 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.
authors.affiliation: Infection Control Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam. athu@hcmc.netnam.vn
authors.forename: Thi Anh Thu
authors.initials: TA
authors.lastname: Le
authors.forename: Annette H
authors.initials: AH
authors.lastname: Sohn
authors.forename: Phuc Tien
authors.initials: PT
authors.lastname: Nguyen
authors.forename: Thi Chi Mai
authors.initials: TC
authors.lastname: Vo
authors.forename: Van Nho
authors.initials: VN
authors.lastname: Vo
authors.forename: Trinh Hanh
authors.initials: TH
authors.lastname: Tran Nguyen
authors.forename: Ben
authors.initials: B
authors.lastname: Ewald
authors.forename: Michael
authors.initials: M
authors.lastname: Dibley
mesh_terms: 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
chemical_list: D000890:Anti-Infective Agents