Current Epidemiology of Ventilator-associated Pneumonia in an Intensive Care Unit in Vietnam

Abstract

BackgroundThe increase of multi-drug-resistant Gram-negative bacteria as a cause of ventilator-associated pneumonia (VAP) is a global concern. The epidemiology of VAP in Southeast Asia remains largely unknown.MethodsThis prospective cohort study was conducted at the Intensive Care Unit (ICU) of Bach Mai Hospital in Hanoi. Patients who received mechanical ventilation for >48 hours, and were diagnosed with VAP, in November 2015–May 2016 were included. Patients with no positive respiratory culture for a causative organism were excluded. Those with multiple VAP episodes >7 days apart with a different causative organism were counted separately.ResultsFifty-six patients (67 episodes) with VAP in 992 admissions were identified. Ten had ≥2 episodes. In 11 episodes, ≥2 isolates were found from a respiratory sample; 78 isolates were identified in total. The cohort median age was 61 (interquartile range [IQR]: 48–70) years, with 43 (76.8%) males. Fourteen (24.6%) patients had diabetes, 10 (17.5%) had chronic kidney diseases, 17 (29.8%) had congestive heart disease, 9 (15.8%) had COPD, and 5 (8.8%) had malignancy. Among isolated bacteria, Acinetobacter baumannii (ACB) was highly resistant to meropenem, levofloxacin, and amikacin (Table). The 7-day mortality was 13% (n = 7) and 31-day mortality was 43.8% (n = 21). ACB cases had higher 31-day mortality (18 [56.2%] vs. 4 [25%]; P = 0.041) and longer ICU stay (16 days [IQR: 10–27] vs. 9 [3–15]; P = 0.024; deceased excluded) than non-ACB. Colistin was used in 23 (41.1%) cases as empiric therapy and 25 (44.6%) as definitive therapy.ConclusionHigh resistance rates and worse clinical outcomes were found in VAP cases due to ACB in ICU in Vietnam. Further study is warranted for appropriate treatment and infection control measures.TableAntimicrobial resistance of bacterial isolates* in ventilator-associated pneumonia, n (%) Acinetobacter baumannii (n = 37) Klebsiella pneumoniae (n = 11) Pseudomonas aeruginosa (n = 15)Meropenem37 (100)7 (63.6)11 (73.3)Ceftazidime37 (100)11 (100)10 (66.7)Levofloxacin37 (100)11 (100)11 (73.3)Amikacin35 (94.6)3 (27.3)10 (66.7)Colistin000*Include Stenotrophomonas maltophilia (n = 6), Serratia marcescens (n = 3), Enterobacter cloacae (n = 2), Elizabethkingia meningoseptica (n = 2).Disclosures All authors: No reported disclosures.