title: Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Intensive Care Unit, National Hospital for Tropical Diseases, Ha Noi, Vietnam.
authors.forename: Vu Dinh
authors.initials: VD
authors.lastname: Phu
authors.affiliation: Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam.|Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.
authors.forename: Heiman F L
authors.initials: HF
authors.lastname: Wertheim
authors.affiliation: Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Larsson
authors.affiliation: Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam.|Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.
authors.forename: Behzad
authors.initials: B
authors.lastname: Nadjm
authors.affiliation: Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam.
authors.forename: Quynh-Dao
authors.initials: QD
authors.lastname: Dinh
authors.affiliation: Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Lennart E
authors.initials: LE
authors.lastname: Nilsson
authors.affiliation: Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Rydell
authors.affiliation: Intensive Care Unit, Bach Mai Hospital, Ha Noi, Vietnam.
authors.forename: Tuyet Thi Diem
authors.initials: TT
authors.lastname: Le
authors.affiliation: Board of Directors, Viet Duc Hospital, Ha Noi, Vietnam.
authors.forename: Son Hong
authors.initials: SH
authors.lastname: Trinh
authors.affiliation: Pharmacy, Saint-Paul Hospital, Ha Noi, Vietnam.
authors.forename: Hung Minh
authors.initials: HM
authors.lastname: Pham
authors.affiliation: Intensive Care Unit, Viet Tiep Hospital, Hai Phong, Vietnam.
authors.forename: Cang Thanh
authors.initials: CT
authors.lastname: Tran
authors.affiliation: Board of Directors, Vietnam-Sweden Uong Bi Hospital, Quang Ninh, Vietnam.
authors.forename: Hanh Thi Hong
authors.initials: HT
authors.lastname: Doan
authors.affiliation: Department of General Internal Medicine & Geriatric, Hue Central General Hospital, Hue, Vietnam.
authors.forename: Nguyen Thua
authors.initials: NT
authors.lastname: Tran
authors.affiliation: Board of Directors, Da Nang Hospital, Da Nang, Vietnam.
authors.forename: Nhan Duc
authors.initials: ND
authors.lastname: Le
authors.affiliation: Infectious Department, Binh Dinh Hospital, Binh Dinh, Vietnam.
authors.forename: Nhuan Van
authors.initials: NV
authors.lastname: Huynh
authors.affiliation: Intensive Care Unit, Khanh Hoa Hospital, Khanh Hoa, Vietnam.
authors.forename: Thao Phuong
authors.initials: TP
authors.lastname: Tran
authors.affiliation: Planning Department, Dak Lak Hospital, Dak Lak, Vietnam.
authors.forename: Bao Duc
authors.initials: BD
authors.lastname: Tran
authors.affiliation: Board of Directors, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
authors.forename: Son Truong
authors.initials: ST
authors.lastname: Nguyen
authors.affiliation: Board of Directors, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
authors.forename: Thao Thi Ngoc
authors.initials: TT
authors.lastname: Pham
authors.affiliation: Board of Directors, Can Tho Central General Hosptial, Can Tho, Vietnam.
authors.forename: Tam Quang
authors.initials: TQ
authors.lastname: Dang
authors.affiliation: Board of directors, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Chau Van Vinh
authors.initials: CV
authors.lastname: Nguyen
authors.affiliation: Board of directors, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Yen Minh
authors.initials: YM
authors.lastname: Lam
authors.affiliation: Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.|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: Board of Directors, National Hospital for Tropical Diseases, Ha Noi, Vietnam.
authors.forename: Kinh
authors.initials: K
authors.lastname: Van Nguyen
authors.affiliation: Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Hakan
authors.initials: H
authors.lastname: Hanberger
mesh_terms: D040981:Acinetobacter baumannii / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D014744:Vietnam / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
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