Hospital-acquired colonization and infections in a Vietnamese intensive care unit

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Microbiology

Background:

• Data on intensive care unit (ICU)-acquired bacterial colonization and infections are limited in low and middle-income countries (LMICs).
• Patients in LMIC ICUs are at elevated risk for colonization and infection with antimicrobial-resistant organisms (AROs).
• Understanding the epidemiology of AROs in Vietnamese ICUs is critical for developing targeted interventions.

Purpose of the Study:

• To assess the incidence and patterns of ICU-acquired bacterial colonization and infections in a Vietnamese hospital.
• To identify key pathogens, including Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Klebsiella spp., Pseudomonas spp., and Acinetobacter spp.
• To determine risk factors associated with ARO colonization and hospital-acquired infections (HAIs) in the ICU setting.

Main Methods:

• A prospective observational study was conducted at the Ho Chi Minh City Hospital for Tropical Diseases, Vietnam.
• Adult patients with over 48 hours of ICU stay were monitored for colonization and infection with specific AROs.
• Data collection included microbiological surveillance and analysis of patient comorbidities and interventions like vascular catheterization.

Main Results:

• A high colonization rate of 61.3% with AROs was observed among ICU patients.
• Significant colonization rates included rectal ESBL-producing E. coli and Klebsiella spp. (44.2%), carbapenemase-producing Acinetobacter spp. (30.8%), and nasal methicillin-resistant S. aureus (14.3%).
• The incidence of HAIs was 23.4%, with vascular catheterization being a significant risk factor for hospital-acquired bloodstream infections. Prior colonization was linked to subsequent ICU-acquired infections.

Conclusions:

• Vietnamese ICU patients exhibit a high prevalence of ARO colonization and a substantial risk of developing subsequent infections.
• The Charlson Comorbidity Index and vascular catheterization emerged as significant risk factors.
• Future research should prioritize colonization monitoring and the development of effective preventive strategies to mitigate ARO spread in ICUs.