Hospital-acquired Colonization and Infections in a Vietnamese Intensive Care Unit

Data concerning intensive care unit (ICU)-acquired bacterial colonization and infections are scarce from low and middle-income countries. ICU patients in these settings are at high risk of becoming colonized and infected with antimicrobial-resistant organisms (AROs). We conducted a prospective observational study at the Ho Chi Minh City Hospital for Tropical Diseases, Vietnam from November 2014 to January 2016 to assess the ICU-acquired colonization and infections, focusing on the five major pathogens in our setting: Staphylococcus aureus, Escherichia coli, Klebsiella spp., Pseudomonas spp. and Acinetobacter spp., among adult patients with more than 48 hours of ICU stay. We found that 61.3% (223/364) of ICU patients became colonized with AROs: 44.2% (161/364) with rectal ESBL-producing Escherichia coli and Klebsiella spp.; 30.8% (40/130) with endotracheal carbapenemase-producing Acinetobacter spp.; and 14.3% (52/364) with nasal methicillin-resistant Staphylococcus aureus. Significant risk factors for AROs colonization were chronic liveriver disease, chronic lung disease, chronic kidney disease, steroids use, ICU admission for non-infectious diseases, and receipt of antimicrobial treatment on ICU admission. Among the 77 patients who developed ICU-acquired infections due to one of the five specified bacteria, 44 (57.1%) had prior colonization with the same organisms. Acquired nasal colonization with any of the five specified bacteria was significantly associated with increased pneumonia and bloodstream infection. Vietnamese ICU patients have a high rate of becoming colonized with AROs and are at risk of subsequent infections if good infection control practices are not in place. Additional research is needed to clarify the potential utility of nasal decolonization in prevention of HAIs.