Stewardship / Resistance Scan for Jun 16, 2017

ICU drug resistance in Vietnam
Resistant pathogens in Nepal

High rate of antimicrobial resistance found in Vietnam ICU patients

A study of intensive care unit (ICU) patients in Ho Chi Minh City, Vietnam, showed high rates of antimicrobial-resistant bacterial infections, according to a report yesterday in BMC Infectious Diseases.

The study group consisted of 220 patients who were admitted to a major tertiary hospital's ICU between November 2014 and September 2015. The authors cultured bronchoalveolar fluid samples and tested the identified microbes for antibiotic susceptibility.

They found that 93% of patients had resistant bacteria, and in 87% of patients the pathogens were resistant to at least two drugs.

Among patients with ventilator–associated pneumonia, Acinetobacter emerged as the leading causative agent, accounting for 42% of 177 microorganisms isolated, followed by Klebsiella species (22%) and Pseudomonas aeruginosa (16%). More than 90% of Acinetobacter isolates were resistant to nine antibiotics, and the Klebsiella and P aeruginosa isolates also showed high rates of multidrug resistance.

Mortality among patients with resistant pathogens was higher than in those without—67% versus 45%—but the difference was not statistically significant.

The authors said their study is the first to examine antimicrobial resistance among hospital patients in Vietnam. They concluded, "The finding here reinforces the view that multidrug resistance is a global public health issue, and emphasizes the need to study combined therapies and rational treatment strategies."
Jun 15 BMC Infect Dis report


Antimicrobial resistance tops 95% among ICU patients in Nepal

More than 95% of gram-negative bacteria isolated from patients with healthcare-associated infections (HAIs) in an ICU in Nepal showed resistance to more than one antimicrobial, says a report published yesterday in Antimicrobial Resistance and Infection Control.

The study involved patients treated in the ICU of Tribhuvan University Teaching Hospital in Kathmandu from January 2014 through March 2015. The authors took clinical specimens from patients who had suspected HAIs, cultured them, and tested bacterial isolates for antimicrobial susceptibility.

The report says 135 of 491 patients were thought to have HAIs, and 149 samples from these patients yielded bacterial growth. Hospital-acquired pneumonia was the leading type of HAI (53%), followed by bloodstream infections, surgical site infections, and urinary tract infections. Acinetobacter species, Klebsiella species, Escherichia coli, and Burkholderia cepacia were the leading pathogens.

The rate of resistance among gram-negative isolates was an "extremely high" 95.8%, the authors wrote. Many of the isolates were producers of beta-lactamases (enzymes that neutralize antibiotics).

"Nearly 96% of the Gram negative bacterial isolates causing nosocomial infections were found multidrug resistant, which is [the] highest ever rate of [multidrug-resistant] bacteria reported from our country," the report says. Further, "a significant proportion (43.3%) of our isolates was extensively drug resistant (XDR)."

Noting that gram-negative pathogens are a major cause of HAIs, the authors called the high level of resistance alarming. "Continuous surveillance and establishment of preventive and control measures of healthcare associated infections are urgently needed in our setting," they concluded.
Jun 15 Antimicrob Resist Infect Control report

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