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. 2025 Oct 9;25(1):1264.
doi: 10.1186/s12879-025-11736-2.

Evaluation of a screening and isolation strategy to curb carbapenem-resistant gram-negative bacteria in Hanoi, Vietnam: a pragmatic before-after study

Nguyen Quang Toan  1 , Buy Tien Sy  2 , Hoang Bao Long  3 , Corinne Tamames  4 , Vu Viet Sang  5 , Nguyen Van Trong  2 , Pham Dang Hai  6 , Ngo Dinh Trung  7 , Nguyen Van Tuyen  8 , Dang Viet Duc  9 , Mai Hong Bang  10 , Le Huu Song  10 , Nguyen Thi Kim Phuong  1 , Jérôme Robert  11   12
Affiliations

Evaluation of a screening and isolation strategy to curb carbapenem-resistant gram-negative bacteria in Hanoi, Vietnam: a pragmatic before-after study

Nguyen Quang Toan et al. BMC Infect Dis. .

Abstract

Background: Carbapenem resistance among gram-negative bacilli is a major threat worldwide, particularly in Vietnam. The study aimed to evaluate the magnitude of carbapenem resistance in gram-negative bacilli in intensive care units (ICU) in Vietnam and evaluate the impact of a screening and isolation strategy on their epidemiology.

Methods: A before-after study was performed where patients were screened for digestive carriage of carbapenem-resistant and carbapenemase-producing gram-negative (CRGN) bacilli at ICU admission and weekly thereafter during a reference period and an intervention period. The intervention consisted of the implementation of isolation precautions for carriers throughout their ICU hospitalization.

Results: The proportion of CRGN digestive carriers at admission was 31.1% in the reference period and 32.6% in the intervention period. The characteristics associated with admission carriage were antibiotic treatment before ICU admission (OR 3.5) and a prior history of hospitalization (OR 1.7). The acquisition rate at ICU discharge was lower in the intervention period (2.79/100 patient-days) than in the reference period (6.85/100 patient-days; P < 0.001). The intervention period was the only characteristic associated with a lower hazard of CRGN bacilli acquisition during the ICU stay (hazard ratio: 0.27, 95%CI 0.21-0.35) in a multivariable Cox model. In addition, the overall compliance with hand hygiene increased significantly in the intervention period (80.0%) as compared to the reference period (52.8%, P < 0.001).

Conclusions: The proportions of carriers of CRGN bacilli at ICU admission and during the ICU stay were very high. The intervention, which included active screening and isolation precautions, along with increased hand hygiene, proved to be efficient in decreasing the CRGN bacilli acquisition rate.

Keywords: Carbapenemase; Hand hygiene; ICU; Isolation precaution; Multidrug resistance; Screening; Vietnam.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The ethical committee for biomedical research of MCH-108 granted ethical clearance for this study (CRE 07/06/2020). This committee is approved by the Ministry of Defense of Vietnam and follows the declaration of Helsinski. Informed consent to participate was obtained from all of the patients included the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial: Not applicable.

Figures

Fig. 1
Fig. 1
Survival curves presenting the probability of being free of carbapenem-resistant gram-negative (CRGN) bacilli, as estimated by the Kaplan‒Meier method, between the reference and intervention periods
See this image and copyright information in PMC

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