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Background <p>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.</p> Methods <p>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.</p> Results <p>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; <i>P</i> &lt; 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%, <i>P</i> &lt; 0.001).</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月9日

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  • Nguyen Quang TOAN,
  • Buy Tien SY,
  • Hoang Bao LONG,
  • Corinne Tamames,
  • Vu Viet SANG,
  • Nguyen Van TRONG,
  • Pham Dang HAI,
  • Ngo Dinh TRUNG,
  • Nguyen Van TUYEN,
  • Dang Viet DUC,
  • Mai Hong BANG,
  • Le Huu SONG,
  • Nguyen Thi Kim PHUONG,
  • Jérôme Robert

摘要

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.