MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH
THAI BINH UNIVERSITY OF MEDICINE AND PHARMACY
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GIANG HOAI NAM
CURRENT SITUATION OF HOSPITAL-ACQUIRED PNEUMONIA
AND ANTIBIOTIC RESISTANT CHARACTERISTICS OF SOME
BACTERIA CAUSING HOSPITAL-ACQUIRED PNEUMONIA
IN THAI BINH PROVINCIAL GENERAL HOSPITAL
IN 2016-2017
Specialization: Sanitary sociology and health organization
Code: 62.72.01.64
DISSERTATION SUMMARY OF MEDICINE
THAI BINH – 2020
The dissertation was done in:
THAI BINH UNIVERSITY OF MEDICINE AND PHARMACY
Supervisors:
1. Assoc. Prof. Hoang Nang Trong
2. Assoc. Prof. Pham Van Trong
Reviewer 1: Assoc. Prof. Nguyen Van Hien
Reviewer 2: Assoc. Prof. Pham Ngoc Chau
Reviewer 3: Assoc. Prof. Nguyen Thi Thuy Duong
The dissertation will be defended in front of the Board of Dissertation
Assessment at: Thai Binh University of Medicine and Pharmacy
At: on 2020
The dissertation could be found in:
- Vietnam National Library
- Library of Thai Binh University of Medicine and Pharmacy
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INTRODUCTION
Hospital-acquired pneumonia (HAP) is infections related to medical
care, which are common in the Intensive care unit and are the leading cause
of death among hospital infections. Hospital-acquired pneumonia is a lung
infection present in a patient who has been and is being treated in the hospital
and takes place at least after 48 hours of admission, not in the incubation
period or infected at the time of admission. The incidence of hospital lung
infections varies by hospital and country. In the US, about 3.63 cases out of
1,000 hospitalized patients got hospital-acquired pneumonia. If the patient is
on mechanical ventilation, the rate of getting hospital-acquired pneumonia
increases 6 to 21 times, the rate increases with mechanical ventilation
duration and 50% of Ventilator-associated pneumonia (VAP) occurs in the
first 4 days of mechanical ventilation. The death rate of Ventilator-
associated pneumonia is from 30 to 70%. In Viet Nam, according to other
studies in hospitals nationwide, the prevalence of HAP was 21 -75% among
the hospital infections. The root cause of HAP is mainly caused by
multidrug resistant Gram-negative bacteria, even against colistin, which is
currently the last weapon used to treat hospital infections.. The most
common gram-negative bacteria causing hospital infections are
A.baumannii, K.pneumoniae, P.aeruginosa, multi-antibiotic E.coli,
antibiotic resistance rate is thought to be very high and varies from country
to country, continents, between hospitals, and even among departments in a
hospital. Hospital infections in general, HAP in particular in Thai Binh
Provincial General Hospital have not been studied and monitored fully and
systematically. Moreover, the resistance characteristics of the pathogen at
the molecular level hasn’t been determined to serve as the basis for
infection prevention and clinical treatment. For those reasons, we
conducted the study: “Current situation of hospital-acquired pneumonia
and antibiotic resistant characteristics of some bacteria causing hospital-
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acquired pneumonia in Thai Binh Provincial General Hospital in the
years 2016-2017” with the following objectives:
RESEARCH OBJECTIVES:
1. Describe the current situation and some related factors causing Hospital-
acquired pneumonia at the Department of Intensive care and Poison control
in Thai Binh Provincial General Hospital in the years 2016-2017.
2. Determine the infection rate and antibiotic resistance characteristics of
some bacteria causing Hospital-acquired pneumonia in the Department of
Intensive care and Poison control in Thai Binh Provincial General Hospital
in the years 2016-2017.
NEW CONTRIBUTIONS OF THE TOPIC
1. This is a relatively complete study of the current situation of hospital-
acquired pneumonia at the Department of Intensive care and Poison control
in Vietnam. The rate of HAP in a provincial unit was 31.0% and the
incidence is 28.1. The main related factors that are likely to cause HAP are:
gender, intervention in respiratory tract invasion and hospitalization
duration.
2. This is the first study in a provincial general hospital in Vietnam using
molecular biology techniques to detect A.baumannii and K.pneumoniae
strains carrying antibiotic resistance genes in groups A, B, D: and detection
of OXA-23, OXA-51, OXA-58 genes and co-carriers of OXA and NDM-1
genes. The analysis also detected the gene OXA-24. So far, studies in
Vietnam have not found any strains of A.baumannii carrying this gene in
bronchial/sputum aspiration fluid of patients with HAP and other studies on
hospital infections.
3. The results of the study set the stage for further studies on related factors,
prevention solutions of HAP, antibiotic resistance levels and the ability to
spread antibiotic resistance genes of A.baumannii and K.pneumoniae in
departments of intensive care at the hospitals.
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LAYOUT OF THE DISSERTATION
The dissertation consists of 127 pages: Introduction: 2 pages, Literature
review: 32 pages; Subject and Research methodology: 21 pages; Research
results: 32 pages, Discussions: 37 pages; Conclusions 2 pages;
Recommendations: 1 page; 38 tables, 6 charts, 5 diagrams, 161 references
including 49 Vietnamese ones and 112 foreign ones.
CHAPTER 1. LITERATURE REVIEW
1.1 . Current situation and some related factors for hospital-acquired
pneumonia
1.1.1. Overview of hospital-acquired pneumonia
A hospital-acquired infection (HAI), also known as a nosocomial
infection, is an infection that is acquired in a hospital or other health care
facility and this infection is neither present nor incubated at the time of
admission. HAI usually appears 48 hours after admission. The overall rate
of HAI for high-income countries generally ranges from 5% to 12%.
According to estimates by the European Center for Disease Prevention and
Control (ECDC), there are about 4,131,000 patients of HAI annually with
about 4,544,100 infections and 37,000 deaths.
1.1.2. Current situation of hospital-acquired pneumonia in the world and
in Vietnam
1.1.2.1. Current situation of hospital-acquired pneumonia in the world
HAP is the second most common type of hospital infections. According
to statistics of many studies, the incidence of HAP accounts for about 0.5 -
5% of the total number of hospitalized patients and accounts for about 10 -
47% of the total number of HAI patients. In an American study, surveying
183 hospitals with 11,282 patients, the rate of HAI is 4%, of which the rate
of HAP accounts for 21.8%. HAP occurs in 25% of infections in ICU and
this number rises to more than 50% for patients who have previously used