title: Emergence of carbapenem-resistant Acinetobacter baumannii as the major cause of ventilator-associated pneumonia in intensive care unit patients at an infectious disease hospital in southern Vietnam.
abstract: Ventilator-associated pneumonia (VAP) is a serious healthcare-associated infection that affects up to 30 % of intubated and mechanically ventilated patients in intensive care units (ICUs) worldwide. The bacterial aetiology and corresponding antimicrobial susceptibility of VAP is highly variable, and can differ between countries, national provinces and even between different wards in the same hospital. We aimed to understand and document changes in the causative agents of VAP and their antimicrobial susceptibility profiles retrospectively over an 11 year period in a major infectious disease hospital in southern Vietnam. Our analysis outlined a significant shift from Pseudomonas aeruginosa to Acinetobacter spp. as the most prevalent bacteria isolated from quantitative tracheal aspirates in patients with VAP in this setting. Antimicrobial resistance was common across all bacterial species and we found a marked proportional annual increase in carbapenem-resistant Acinetobacter spp. over a 3 year period from 2008 (annual trend; odds ratio 1.656, P = 0.010). We further investigated the possible emergence of a carbapenem-resistant Acinetobacter baumannii clone by multiple-locus variable number tandem repeat analysis, finding a blaOXA-23-positive strain that was associated with an upsurge in the isolation of this pathogen. We additionally identified a single blaNDM-1-positive A. baumannii isolate. This work highlights the emergence of a carbapenem-resistant clone of A. baumannii and a worrying trend of antimicrobial resistance in the ICU of the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam.
authors.affiliation: School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.|The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen Thi Khanh
authors.initials: NTK
authors.lastname: Nhu
authors.affiliation: The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.|The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen Phu Huong
authors.initials: NPH
authors.lastname: Lan
authors.affiliation: Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.|The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: James I
authors.initials: JI
authors.lastname: Campbell
authors.affiliation: Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.|Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.|The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
authors.affiliation: Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.|The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Corinne
authors.initials: C
authors.lastname: Thompson
authors.affiliation: The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Ha Thanh
authors.initials: HT
authors.lastname: Tuyen
authors.affiliation: The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen Van Minh
authors.initials: NVM
authors.lastname: Hoang
authors.affiliation: The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Pham Thi Thanh
authors.initials: PTT
authors.lastname: Tam
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of California San Francisco, CA, USA.|The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Vien Minh
authors.initials: VM
authors.lastname: Le
authors.affiliation: The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Tran Vu Thieu
authors.initials: TVT
authors.lastname: Nga
authors.affiliation: The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Tran Do Hoang
authors.initials: TDH
authors.lastname: Nhu
authors.affiliation: The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Pham
authors.initials: P
authors.lastname: Van Minh
authors.affiliation: The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen Thi Thu
authors.initials: NTT
authors.lastname: Nga
authors.affiliation: The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Cao Thu
authors.initials: CT
authors.lastname: Thuy
authors.affiliation: The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Le Thi
authors.initials: LT
authors.lastname: Dung
authors.affiliation: The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen Thi Thu
authors.initials: NTT
authors.lastname: Yen
authors.affiliation: School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Van Hao
authors.affiliation: The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Huynh Thi
authors.initials: HT
authors.lastname: Loan
authors.affiliation: The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Lam Minh
authors.initials: LM
authors.lastname: Yen
authors.affiliation: Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.|School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.|The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Ho Dang Trung
authors.initials: HDT
authors.lastname: Nghia
authors.affiliation: The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Tran Tinh
authors.initials: TT
authors.lastname: Hien
authors.affiliation: Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.|The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Louise
authors.initials: L
authors.lastname: Thwaites
authors.affiliation: Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.|The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Guy
authors.initials: G
authors.lastname: Thwaites
authors.affiliation: School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Nguyen Van Vinh
authors.initials: NVV
authors.lastname: Chau
authors.affiliation: The London School of Hygiene and Tropical Medicine, London, UK.|Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.|The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015780:Carbapenems / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000382:microbiology*; D015995:Prevalence; D012189:Retrospective Studies; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D015780:Carbapenems; D004269:DNA, Bacterial