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High prevalence of multidrug-resistant intestinal bacteria in Vietnamese hospitals

About half of the hospitalized patients in Vietnam carry multidrug-resistant gut bacteria that are resistant to carbapenems, a group of broad-spectrum antibiotics. This is the result of a study by Swedish and Vietnamese scientists led by the University of Linköping, published in the Journal of Infection .

"In our study, we note a high prevalence of multidrug-resistant gut bacteria in Vietnamese hospitals The longer the patients are in the hospital, the greater the risk that they will be infected with carbapenem-resistant gut bacteria," says Håkan Hanberger, a professor at the Department of clinical and experimental medicine at the University of Linköping and consultant at the Infection Clinic in Linköping University Hospital.

Carbapenem-resistant Enterobacteriaceae (CRE) are a serious problem for several reasons. They are resistant to almost all broad-spectrum antibiotics, making infection by these bacteria difficult to treat. In addition, CRE can pass antibiotic resistance genes to other bacteria, making them resistant to the carbapenem group of antibiotics. Intestinal bacteria spread easily, z. On hands and furniture used to care for infants. They cause various types of infections, especially urinary tract infections, sepsis and pneumonia. These multidrug-resistant gut bacteria are spreading rapidly around the world, and WHO has prioritized measures to curb the spread of CRE and develop new antibiotics against these bacteria.

The study was included in Journal of Infection more than 2,200 patients who were enrolled in 63 different wards in 1

2 hospitals in different parts of Vietnam. Rectal swabs were taken from the patients and examined for the presence of CRE. Being a carrier is a risk factor for a clinical infection with the bacteria, but not all carriers become ill.

Risk factors for transmission of multidrug-resistant gut bacteria were prolonged hospitalization and infection during the stay, known as "hospital-acquired infection". One in eight (13%) patients were carriers at admission who had increased to seven out of eight (87%) after two weeks of hospitalization. Another risk factor for patients in the study was treatment with carbapenem, which contributes to the selection of carbapenem-resistant bacteria.

In a sub-study of 328 neonates in a neonatal intensive care unit, the researchers found that mortality is related to being a carrier of CRE and having a hospital-acquired infection when admitted to the ward (odds ratio 5) , 5, p <0.01).

The sub-study looked at the most vulnerable patients, neonates in need of intensive care, and showed that mortality was five times higher in patients with hospital-acquired infection and as carriers of multidrug-resistant CRE.

Håkan Hanberger, Professor, Department of Clinical and Experimental Medicine, University of Linköping [19659009] The researchers conclude that there is an epidemic spread in Vietnamese hospitals of multidrug-resistant intestinal bacteria with rapid transmission to hospitalized patients.

"The extensive spread Carbapenem-resisting intestinal bacteria means that forced action must be taken to reduce the transmission of hospital infections, improve hand hygiene, use sterile working practices during surgery and in the management of venous catheters, and isolate patients suffering from multidrug-resistant bowel disease affected are bacteria. It is also important to have effective follow-up care if patients are discharged from the hospital to reduce the spread of these bacteria in the population. But even if we do everything right, it will take a long time for the infections to sink to an acceptable level, "says Håkan Hanberger.

In the case of Sweden, the presence of carbapenem-resistant bacteria has been extremely low.

" Sweden is one the countries of the world where the situation is most favorable for carbapenem resistant intestinal bacteria. It's one of the countries that can probably slow the spread the longest, but we also need to improve hygiene in healthcare in Sweden, "says Håkan Hanberger.
The study was supported by, among others, Karolinska Institutet, Linköping University, Östergötland Region, the Swedish Foundation for International Cooperation in Research and Higher Education (STINT), ReAct – Action on Antibiotic Resistance and the participating hospitals.


Journal Reference:

Tran, D.M. et al. . (2019) High prevalence of colonization with carbapenem-resistant Enterobacteriaceae in patients admitted to Vietnamese hospitals: risk factors and disease burden. Journal of Infection . doi.org/10.1016/j.jinf.2019.05.013[19659016[//
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