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Clinical and microbiological evaluation of ventilator-associated pneumonia in an intensive care unit in Vietnam
Kayoko Hayakawa1,2, Nguyen Gia Binh3, Dao Xuan Co3
1Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Background:
The increasing incidence of multidrug-resistant Gram-negative bacteria causing ventilator-associated pneumonia (VAP) is a global concern. A better understanding of the epidemiology of VAP in Southeast Asia is essential to optimise treatments and patient outcomes.
Methods:
VAP epidemiology in an intensive care unit in Vietnam was investigated. A prospective cohort study was conducted. Patients who were ventilated for >48 hours, diagnosed with VAP, and had a positive respiratory culture between October 2015 and March 2017 were included. Whole-genome sequencing (WGS) was performed on Acinetobacter baumannii isolates.
Results:
We identified 125 patients (137 episodes) with VAP from 1,699 admissions. Twelve patients had 2 VAP episodes. The median age was 60 years (interquartile range: 48-70), and 68.8% of patients were male. Diabetes mellitus was the most frequent comorbidity (N=35, 28%). Acinetobacter baumannii was most frequently isolated in the first VAP episode (N=84, 67.2%) and was multiply resistant to meropenem, levofloxacin, and amikacin. The 30-day mortality rate was 55.2% (N=69) and higher in patients infected with A. baumannii (N=52, 65%). WGS results suggested a complex spread of multiple clones.
Conclusions:
In an intensive care unit in Vietnam, VAP due to A. baumannii had a high mortality rate, and A. baumannii and K. pneumoniae were multidrug resistant, with carbapenem resistance of 97% and 70%, respectively.
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