Burden of carbapenem-resistant Gram-negative bacterial infections in Vietnam: a national hospital survey.

INTRODUCTION

The World Health Organization Bacterial Pathogen Priority List 2024 highlights carbapenem-resistant Gram-negative bacteria (CRGNB), including Enterobacterales (CRE), Acinetobacter baumannii (CRAB) and 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 the 63 provinces of Vietnam, which then forwarded it to district and private hospitals.

RESULTS

In total, 324 hospitals participated in this study: 20 central hospitals, 190 provincial hospitals, 106 district hospitals and eight private hospitals. 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%), A. baumannii (CRAB 64%) and P. aeruginosa (CRPA 39%). CRE sepsis treatment included cephalosporins, aminoglycosides, carbapenems, fluoroquinolones and colistin. CRE infections were associated with higher crude mortality rates (31.7% vs 20.2%; P<0.001), longer hospital stays (10.4 vs 8.9 days; P<0.001), and higher costs (1025 vs 773; P<0.001) compared with 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. There is an urgent need to strengthen the microbiological infrastructure, improve CRGNB screening, and enhance IPC measures.