BURDEN OF CARBAPENEM RESISTANT GRAM-NEGATIVE BACTERIAL INFECTIONS IN VIETNAM - A NATIONAL HOSPITAL SURVEY

Abstract

Introduction: The WHO Bacterial Pathogen Priority List 2024 highlights Carbapenem-Resistant Gram-Negative Bacteria (CRGNB), including Enterobacterales (CRE) and Acinetobacter baumannii (CRAB), followed by Pseudomonas aeruginosa (CRPA), as top priorities due to their virulence, resistance, transmission, and limited treatment options.

Objective: This national hospital survey aimed to assess the burden of CRGNB infections and evaluate microbiological laboratory capacity across Vietnam.

Methods: An online survey was distributed to central hospitals and provincial Departments of Health in Vietnam's 63 provinces, which then forwarded it to district and private hospitals.

Results: A total of 324 hospitals participated: 20 central, 190 provincial, 106 district, and 8 private. Half reported microbiological capacity for bacterial culture and susceptibility testing. Among 57,667 reported Gram-negative isolates, 17,417 (30.2%) were CRGNB, including Klebsiella pneumoniae (CRE 37%), Escherichia coli (CRE 11%), Acinetobacter baumannii (CRAB 64%), and Pseudomonas aeruginosa (CRPA 39%). CRE sepsis treatment included cephalosporins, aminoglycosides, carbapenems, fluoroquinolones, and colistin. CRE infections were associated with higher crude mortality (31.7% vs. 20.2%, p<0.001), longer hospital stays (10.4 vs. 8.9 days, p<0.001), and higher costs (1,025vs.1,025vs.773, p<0.001) compared to carbapenem-susceptible Enterobacterales. Reported infection prevention and control (IPC) interventions included CRE surveillance (41%), isolation (36%), point prevalence surveys (15%), and cohort care (7%). IPC funding sources included general health insurance (40%) and hospital funds (32%).

Conclusion: CRGNB pose a significant burden in terms of morbidity, mortality, and financial impact. Strengthening microbiological infrastructure, improving CRGNB screening, and enhancing IPC measures are urgently needed.