title: High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: A multi-centre point prevalence survey.
abstract: There is scarce information regarding hospital-acquired infections (HAIs) among children in resource-constrained settings. This study aims to measure prevalence of HAIs in Vietnamese pediatric hospitals.Monthly point prevalence surveys (PPSs) in 6 pediatric intensive care units (ICUs) in 3 referral hospitals during 1 year.A total of 1363 cases (1143 children) were surveyed, 59.9% male, average age 11 months. Admission sources were: other hospital 49.3%, current hospital 36.5%, and community 15.3%. Reasons for admission were: infectious disease (66%), noninfectious (20.8%), and surgery/trauma (11.3%). Intubation rate was 47.8%, central venous catheter 29.4%, peripheral venous catheter 86.2%, urinary catheter 14.6%, and hemodialysis/filtration 1.7%. HAI was diagnosed in 33.1% of the cases: pneumonia (52.2%), septicemia (26.4%), surgical site infection (2%), and necrotizing enterocolitis (2%). Significant risk factors for HAI included age under 7 months, intubation and infection at admission. Microbiological findings were reported in 212 cases (43%) with 276 isolates: 50 Klebsiella pneumoniae, 46 Pseudomonas aeruginosa, and 39 Acinetobacter baumannii, with carbapenem resistance detected in 55%, 71%, and 65%, respectively. Staphylococcus aureus was cultured in 18 cases, with 81% methicillin-resistant Staphylococcus aureus. Most children (87.6%) received antibiotics, with an average of 1.6 antibiotics per case. Colistin was administered to 96 patients, 93% with HAI and 49% with culture confirmed carbapenem resistance.The high prevalence of HAI with carbapenem resistant gram-negative strains and common treatment with broad-spectrum antibiotics and colistin suggests that interventions are needed to prevent HAI and to optimize antibiotic use.
authors.affiliation: National Hospital of Pediatrics, Hanoi Oxford University Clinical Research Unit, Vietnam; Nuffield Department of Medicine, Centre for Tropical Medicine, University of Oxford, UK Department of Medical Microbiology, RCI, Radboudumc, Nijmegen, Netherlands National Hospital for Tropical Diseases, Hanoi Children's Hospital 1, HCMC Hospital for Tropical Diseases, HCMC Linköping University, Sweden Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ngai Kien
authors.initials: NK
authors.lastname: Le
authors.forename: Wertheim
authors.initials: W
authors.lastname: Hf
authors.forename: Phu Dinh
authors.initials: PD
authors.lastname: Vu
authors.forename: Dung Thi Khanh
authors.initials: DTK
authors.lastname: Khu
authors.forename: Hai Thanh
authors.initials: HT
authors.lastname: Le
authors.forename: Bich Thi Ngoc
authors.initials: BTN
authors.lastname: Hoang
authors.forename: Vu Thanh
authors.initials: VT
authors.lastname: Vo
authors.forename: Yen Minh
authors.initials: YM
authors.lastname: Lam
authors.forename: Dung Tien Viet
authors.initials: DTV
authors.lastname: Vu
authors.forename: Thu Hoai
authors.initials: TH
authors.lastname: Nguyen
authors.forename: Tung Quang
authors.initials: TQ
authors.lastname: Thai
authors.forename: Lennart E
authors.initials: LE
authors.lastname: Nilsson
authors.forename: Ulf
authors.initials: U
authors.lastname: Rydell
authors.forename: Kinh Van
authors.initials: KV
authors.lastname: Nguyen
authors.forename: Behzad
authors.initials: B
authors.lastname: Nadjm
authors.forename: Louise
authors.initials: L
authors.lastname: Clarkson
authors.forename: Håkan
authors.initials: H
authors.lastname: Hanberger
authors.forename: Mattias
authors.initials: M
authors.lastname: Larsson
mesh_terms: D015780:Carbapenems / Q000494:pharmacology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D015995:Prevalence; D014744:Vietnam / Q000453:epidemiology
chemical_list: D015780:Carbapenems