title: Need for improved antimicrobial and infection control stewardship in Vietnamese intensive care units.
abstract: OBJECTIVE
  Survey of antibiotic consumption, microbial resistance and hygiene precautions in the intensive care units of three hospitals in northern Vietnam.
  
  
  METHODS
  Observational study. Data were collected from the microbiological laboratories. Antibiotic consumption was determined based on quantities of drugs delivered from the pharmacy. A protocol to observe the application of hygiene precautions was developed and used. Bacteria were typed and tested for drug susceptibility using the disc-diffusion method.
  
  
  RESULTS
  The mean antibiotic consumption was 811 defined daily doses per 1000 occupied bed days. The most commonly used antibiotics were third-generation cephalosporins, followed by carbapenems, amoxicillin and ampicillin. Eighty per cent of bacterial isolates were Gram-negative. The most common pathogens found in blood cultures were Escherichia coli and Klebsiella spp., Pseudomonas spp., Acinetobacter spp., Staphylococcus aureus and Enterococcus faecalis. Acinetobacter and Pseudomonas spp. were the two most frequently isolated bacteria from the respiratory tract and all other sources together. Seventy per cent of Acinetobacter species showed reduced susceptibility to imipenem, 80% to ciprofloxacin and 89% to ceftazidime. Forty-four per cent of Pseudomonas spp. showed reduced susceptibility to imipenem, 49% to ciprofloxacin and 49% to ceftazidime. Escherichia coli was fully susceptible to imipenem, but 57% of samples were resistant to both ciprofloxacin and cefotaxime. Hygiene precautions were poor, and fewer than 50% of patient contacts incorporated appropriate hand hygiene.
  
  
  CONCLUSIONS
  Low antibiotic consumption, poor hygiene precautions and the high level of antibiotic resistance indicate that there is room for improvement regarding antibiotic use and infection control.
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. magnus.johansson86@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Johansson
authors.forename: D M
authors.initials: DM
authors.lastname: Phuong
authors.forename: S M
authors.initials: SM
authors.lastname: Walther
authors.forename: H
authors.initials: H
authors.lastname: Hanberger
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001419:Bacteria / Q000302:isolation & purification; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D006235:Hand Disinfection / Q000592:standards; D006801:Humans; D006920:Hygiene / Q000592:standards; D017053:Infection Control / Q000379:methods / Q000592:standards*; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008826:Microbial Sensitivity Tests; D014744:Vietnam
chemical_list: D000900:Anti-Bacterial Agents