Burden, Etiology and Control of Hospital Acquired Infections in Intensive Care Units in Vietnam

Vu Dinh Phu (2017). Burden, Etiology and Control of Hospital Acquired Infections in Intensive Care Units in Vietnam. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.0000c5f1


Hospital acquired infection (HAI) is one of the most frequent adverse event in healthcare worldwide, affecting hundreds of millions of patients annually. In both developed and developing countries, this burden falls mainly on the critically ill. In Vietnam, HAI data are limited, particularly from the intensive care units (ICUs). Robust data are needed to evaluate these problems. This thesis addresses this need.

A point prevalence survey (PPS) of HAI and antibiotics use was conducted monthly at 15 ICUs of 14 tertiary and provincial hospitals across Vietnam from October 2012 to September 2013. Subsequently an observational study focused on ventilator associated pneumonia (VAP) and ventilator associated respiratory infections (VARI) at the ICUs of three referral hospitals in Hanoi and Ho Chi Minh City from November 2013 to November 2015.

Analysis of 3287 patients in the PPS showed that 29.5% patients had at least one HAI on the surveyed day of which 80% was hospital acquired pneumonia. Antibiotics were being administered to 84.8% patients. A. baumannii, P. aeruginosa, and K. pneumoniae accounted for > 50% of HAI pathogens with carbapenem resistance rates of 89.2%, 55.7%, and 14.9% respectively. The presence of an invasive device was associated with significantly higher risk for HAI.

The incidence of VAP and VARI in 374 patients analysed as part of the second study was 9.9% and 24.6% respectively with corresponding incidence densities of 7.6 and 21.4 episodes/1000 ventilation days respectively. Patients with VARI had an excess ICU stay of 11 days, ventilation duration 12.5 days, antibiotic consumption 11 DOT; and ICU cost 2189 US$ compared with those without VARI. Given an estimated 22,570 patients admitted to the ICUs of 14 surveyed hospitals in 2012 and VARI prevalence of 24.6%, we would expect 5552 patients developed VARI leading to an extra 69,403 ventilation days, 61,074 ICU days, 61,074 DOT antibiotic consumption, and an extra ICU cost of 12,153,810 US$. With a total of 40 tertiary and 304 provincial acute care hospitals across Vietnam, the extra cost for VARI nationally would be many times higher.

In conclusion, this thesis provides compelling evidence that the burden of HAI in Vietnamese ICUs, particularly VAP/VARI, is substantial. There is also a high level of antibiotic consumption and widespread bacterial resistance to carbapenem antibiotics. Effective infection control measures and antibiotic stewardship programmes are urgently needed to address these problems in Vietnamese ICUs.

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