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  • 1.
    Fransen, Jian
    et al.
    Uppsala University, Sweden.
    Huss, Fredrik R. M.
    Uppsala University, Sweden; University of Uppsala Hospital, Sweden.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Rydell, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Surveillance of antibiotic susceptibility in a Swedish Burn Center 1994-20122016In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 42, no 6, p. 1295-1303Article in journal (Refereed)
    Abstract [en]

    Patients with burn trauma are at risk for infections caused by antibiotic resistant bacteria (ABR) with subsequent increase in morbidity and mortality. As part of the Swedish strategic program against antibiotic resistance in intensive care (ICU-Strama), we have surveyed the distribution of species and ABR in isolates from patients admitted to a Swedish burn center at Linkoping University Hospital from 1994 through 2012. In an international comparison Strama has been successful in reducing the antibiotic consumption among animals and humans in primary care. The aim of this study was to investigate the antibiotic consumption pressure and resistance rates in a Swedish burn unit. Methods: Microbiology data, total body surface area (TBSA), patient days, and mortality were collected from a hospital database for all patients admitted to the Burn Center at the University Hospital of Linkoping from April 1994 through December 2012. Results: A total of 1570 patients were admitted with a mean annual admission rate of 83 patients (range: 57-152). 15,006 microbiology cultures (approximately 10 per patient) were collected during the study period and of these 4531 were positive (approximately 3 per patient). The annual mean total body surface area (TBSA) was 13.4% (range 9.5-18.5) with an annual mortality rate of 5.4% (range 1-8%). The MRSA incidence was 1.7% (15/866) which corresponds to an MRSA incidence of 0.34/1000 admission days (TAD). Corresponding figures were for Escherichia coli resistant to 3rd generation cephalosporins (ESBL phenotype) 8% (13/170) and 0.3/TAD, Klebsiella spp. ESBL phenotype 5% (6/134) and 0.14/TAD, carbapenem resistant Pseudomonas aeruginosa 26% (56/209) and 1.28/TAD, and carbapenem resistant Acinetobacter spp. 3% (2/64) and 0.04/TAD. Conclusions: Our results show a sustained low risk for MRSA and high, although not increasing, risk for carbapenem resistant P. aeruginosa. (C) 2016 Elsevier Ltd and ISBI. All rights reserved.

  • 2.
    Le, Ngai Kien
    et al.
    Natl Hosp Pediat, Hanoi, Vietnam.
    Wertheim, HF
    Univ Oxford, Clin Res Unit, Hanoi, Vietnam; Univ Oxford, Ctr Trop Med, Nuffield Dept Med, Oxford, England; Radboudumc, RCI, Dept Med Microbiol, Nijmegen, Netherlands.
    Vu, Phu Dinh
    Natl Hosp Trop Dis, Hanoi, Vietnam.
    Khu, Dung Thi Khanh
    Natl Hosp Pediat, Hanoi, Vietnam.
    Le, Hai Tanh
    Natl Hosp Pediat, Hanoi, Vietnam.
    Hoang, Bich Thi Ngoc
    Natl Hosp Pediat, Hanoi, Vietnam.
    Vo, Vu Thanh
    HCMC, Childrens Hosp 1, Hanoi, Vietnam.
    Lam, YM
    HCMC, Hosp Trop Dis, Hanoi, Vietnam.
    Vu, DTV
    Univ Oxford, Clin Res Unit, Hanoi, Vietnam; Univ Oxford, Ctr Trop Med, Nuffield Dept Med, Oxford OX1 2JD, England.
    Nguyen, TH
    Natl Hosp Pediat, Hanoi, Vietnam.
    Thai, TQ
    HCMC, Childrens Hosp 1, Hanoi, Vietnam.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Rydell, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Van Nguyen, K
    HCMC, Hosp Trop Dis, Hanoi, Vietnam.
    Nadjm, Behzad
    Univ Oxford, Clin Res Unit, Hanoi, Vietnam; Univ Oxford, Ctr Trop Med, Nuffield Dept Med, Oxford OX1 2JD, England.
    Clarkson, Louise
    Karolinska Inst, Stockholm, Sweden.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Larsson, Mattias
    University of Oxford, Vietnam; University of Oxford, England; Karolinska Institute, Sweden.
    High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs A multi-centre point prevalence survey2016In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 95, no 27, article id e4099Article in journal (Refereed)
    Abstract [en]

    There is scarce information regarding hospital-acquired infections (HAIs) among children in resource-constrained settings. This study aims to measure prevalence of HAIs in Vietnamese pediatric hospitals. Monthly point prevalence surveys (PPSs) in 6 pediatric intensive care units (ICUs) in 3 referral hospitals during 1 year. A total of 1363 cases (1143 children) were surveyed, 59.9% male, average age 11 months. Admission sources were: other hospital 49.3%, current hospital 36.5%, and community 15.3%. Reasons for admission were: infectious disease (66%), noninfectious (20.8%), and surgery/trauma (11.3%). Intubation rate was 47.8%, central venous catheter 29.4%, peripheral venous catheter 86.2%, urinary catheter 14.6%, and hemodialysis/filtration 1.7%. HAI was diagnosed in 33.1% of the cases: pneumonia (52.2%), septicemia (26.4%), surgical site infection (2%), and necrotizing enterocolitis (2%). Significant risk factors for HAI included age under 7 months, intubation and infection at admission. Microbiological findings were reported in 212 cases (43%) with 276 isolates: 50 Klebsiella pneumoniae, 46 Pseudomonas aeruginosa, and 39 Acinetobacter baumannii, with carbapenem resistance detected in 55%, 71%, and 65%, respectively. Staphylococcus aureus was cultured in 18 cases, with 81% methicillin-resistant Staphylococcus aureus. Most children (87.6%) received antibiotics, with an average of 1.6 antibiotics per case. Colistin was administered to 96 patients, 93% with HAI and 49% with culture confirmed carbapenem resistance. The high prevalence of HAI with carbapenem resistant gram-negative strains and common treatment with broad-spectrum antibiotics and colistin suggests that interventions are needed to prevent HAI and to optimize antibiotic use.

  • 3.
    Phu, Vu Dinh
    et al.
    Natl Hosp Trop Dis, Intens Care Unit, Hanoi, Vietnam.
    Wertheim, Heiman FL
    Univ Oxford, Clin Res Unit, Wellcome Trust Major Overseas Programme, Hanoi, Vietnam; Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, Oxford OX1 2JD, England.
    Larsson, Mattias
    Karolinska Institute, Sweden.
    Nadjm, Behzad
    University of Oxford, England.
    Dinh, Quynh-Dao
    Univ Oxford, Clin Res Unit, Wellcome Trust Major Overseas Programme, Hanoi, Vietnam.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Rydell, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Le, Tuyet Thi Diem
    Bach Mai Hosp, Intens Care Unit, Hanoi, Vietnam.
    Trinh, Son Hong
    Viet Duc Hosp, Board Directors, Hanoi, Vietnam.
    Pham, Hung Minh
    St Paul Hosp, Pharm, Hanoi, Vietnam.
    Tran, Cang Thanh
    Viet Tiep Hosp, Intens Care, Hai Phong, Vietnam.
    Doan, Hanh Thi Hong
    Vietnam Sweden Uong Bi Hosp, Board Directors, Quang Ninh, Vietnam.
    Tran, Nguyen Thua
    Hue Cent Gen Hosp, Dept Gen Internal Med & Geriatr, Hue, Vietnam.
    Le, Nhan Duc
    Da Nang Hosp, Board Directors, Da Nang, Vietnam.
    Van Huynh, Nhuan
    Binh Dinh Hosp, Infect Dept, Binh Dinh, Vietnam.
    Tran, Thao Phuong
    Khanh Hoa Hosp, Intens Care Unit, Khanh Hoa, Vietnam.
    Tran, Bao Duc
    Dak Lak Hosp, Planning Dept, Dak Lak, Vietnam.
    Nguyen, Son Truong
    Cho Ray Hosp, Board Directors, Ho Chi Minh City, Vietnam.
    Pham, Thao Thi Ngoc
    Cho Ray Hosp, Board Directors, Ho Chi Minh City, Vietnam.
    Dang, Tam Quang
    Can Tho Cent Gen Hosptial, Board Directors, Can Tho, Vietnam.
    Nguyen, Chau Van Vinh
    Hosp Trop Dis, Board Directors, Ho Chi Minh City, Vietnam.
    Lam, Yen Minh
    Hosp Trop Dis, Board Directors, Ho Chi Minh City, Vietnam.
    Thwaites, Guy
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, Oxford OX1 2JD, England; Univ Oxford, Clin Res Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
    Van Nguyen, Kinh
    Natl Hosp Trop Dis, Board Directors, Hanoi, Vietnam.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 1, article id e0147544Article in journal (Refereed)
    Abstract [en]

    Background Vietnam is a lower middle-income country with no national surveillance system for hospital-acquired infections (HAIs). We assessed the prevalence of hospital-acquired infections and antimicrobial use in adult intensive care units (ICUs) across Vietnam. Methods Monthly repeated point prevalence surveys were systematically conducted to assess HAI prevalence and antimicrobial use in 15 adult ICUs across Vietnam. Adults admitted to participating ICUs before 08: 00 a.m. on the survey day were included. Results Among 3287 patients enrolled, the HAI prevalence was 29.5% (965/3266 patients, 21 missing). Pneumonia accounted for 79.4% (804/1012) of HAIs Most HAIs (84.5% [855/1012]) were acquired in the survey hospital with 42.5% (363/855) acquired prior to ICU admission and 57.5% (492/855) developed during ICU admission. In multivariate analysis, the strongest risk factors for HAI acquired in ICU were: intubation (OR 2.76), urinary catheter (OR 2.12), no involvement of a family member in patient care (OR 1.94), and surgery after admission (OR 1.66). 726 bacterial isolates were cultured from 622/1012 HAIs, most frequently Acinetobacter baumannii (177/726 [24.4%]), Pseudomonas aeruginosa (100/726 [13.8%]), and Klebsiella pneumoniae (84/726 [11.6%]), with carbapenem resistance rates of 89.2%, 55.7%, and 14.9% respectively. Antimicrobials were prescribed for 84.8% (2787/ 3287) patients, with 73.7% of patients receiving two or more. The most common antimicrobial groups were third generation cephalosporins, fluoroquinolones, and carbapenems (20.1%, 19.4%, and 14.1% of total antimicrobials, respectively). Conclusion A high prevalence of HAIs was observed, mainly caused by Gram-negative bacteria with high carbapenem resistance rates. This in combination with a high rate of antimicrobial use illustrates the urgent need to improve rational antimicrobial use and infection control efforts.

  • 4.
    Wertheim, Heiman F. L.
    et al.
    Oxford University Clinical Research Unit, Hanoi, Viet Nam.
    Chandna, Arjun
    Oxford University Clinical Research Unit, Hanoi, Viet Nam.
    Dinh Vu, Phu
    National Hospital for Tropical Diseases, Hanoi, Viet Nam.
    Van Pham, Ca
    National Hospital for Tropical Diseases, Hanoi, Viet Nam.
    Thi Nguyen, Phong Dai
    National Hospital for Tropical Diseases, Hanoi, Viet Nam.
    Minh Lam, Yen
    National Hospital for Tropical Diseases, Hanoi, Viet Nam.
    Van Nguyen, Chau Vinh
    Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam.
    Larsson, Mattias
    Oxford University Clinical Research Unit, Hanoi, Viet Nam.
    Rydell, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Farrar, Jeremy
    University of Oxford, Vietnam South East Asia Infect Disease Clin Research Network, Vietnam.
    Van Nguyen, Kinh
    National Hospital for Tropical Diseases, Hanoi, Viet Nam.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Providing Impetus, Tools, and Guidance to Strengthen National Capacity for Antimicrobial Stewardship in Viet Nam2013In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 10, no 5Article in journal (Other academic)
    Abstract [en]

    n/a

1 - 4 of 4
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