O54 – A Comparison of ICU infections in a United States Trauma Center and a Teaching Hospital in Ho Chi Minh City, Vietnam

Author(s):
Andrew Stephen, Minh Tran, Bich Sim, Stephanie Lueckel, Michael Connolly, Daithi Heffernan, Charles Adams, William Cioffi, Brown University, Rhode Island Hospital

Background: Infectious complications remain prominent causes of morbidity in Intensive Care Units (ICUs) worldwide. International collaborations allow establishment of common protocols. Despite isolation rooms and antibiotic stewardship, resistant organisms are increasing. To establish common practices it is critical to establish the microbiological flora of collaborating international ICU’s.

Hypothesis: Microbial patterns and resistant profiles vary vastly between international ICU’s.

Methods: Prospectively gathered data from a Level 1 trauma center in Rhode Island (RIH) and patients in a mixed ICU in Ho Chi Minh City, Vietnam (HCM) over a one year period. Demographic, microbiologic and antibiotic resistant data of respiratory tract infections (RTIs), blood stream infections (BSIs) and urinary tract infections (UTIs) was collected. We compared logistics of isolation, patient distancing, cleaning practices and antibiotic tailoring between the two ICUs.

Results: For both ICUs, RTIs were the most frequent infection. In HCM, BSIs were second followed by UTI. In RIH UTIs were second and BSIs third most frequent. Overall, in HCM gram neg organisms predominated, (Acinetobacter=35.5% of all infections), whereas a greater frequency of gram pos organisms were noted at RIH (Acinetobacter<2% of infections). The most common RTIs in HCM were Acinetobacter(43%) and Klebsiella(17%). Within RIH RTIs these were Staph aureus(38.3%) and H. influenza(10.4%). In the UTIs there was no difference in common organisms between HCM and RIH-E.coli 31% vs 50%;p=0.14 and enterococcus 21% vs 13%;p=0.51. Again gram neg predominated BSIs in HCM (Acinetobacter-19% and Klebsiella-16%) with infrequent Staph aureus, whereas Staph aureus accounted for 50% of the RIH BSIs. In assessing resistance profiles of all infections no cases of either pan-resistant Acinetobacter or vancomycin resistant enterococcus (VRE) were noted in either ICU. Among Staph aureus infections, there was no difference in MRSA infection rates(31% vs 40%; p=0.15).

Conclusions: RTIs are the most common ICU infection. Microbial profiles vary distinctly. Despite disparate set ups, including close patient proximity and poor contact precautions in HCM, there is no difference in antibiotic resistance profiles. Further work will address common international risk factors for infections in the critically ill.