390. Epidemiology and Outcomes of Healthcare-Associated Pneumonia, Bach Mai Hospital, Vietnam
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: despite strict infection control practices, hospital-acquired pneumonia (HAP) have been increasing among patients admitted to the intensive care unit (ICU) at Bach Mai Hospital (BMH), the largest hospital in Vietnam. We conducted this study to characterize the epidemiology of HAP and assess the impact on patient outcomes and hospital costs.
Methods: During September 2006 to September 2007 (study period), consecutive patients admitted to the BMH ICU for >48 hours were followed and outcomes documented. Patients diagnosed with HAP were compared with a control group without HAP.
Results: of 808 patients admitted to the BMH ICU during the study period, 172 (21.3%) were diagnosed with HAP and 492 (61%) were mechanically ventilated. Of the 172 patients with HAP, 144 (84%) were classified as ventilator-associated pneumonia (VAP). The risk of acquiring a VAP was 29.3% (144/492). Independent risk factors for HAP were mechanical ventilation (odds ratio [OR] = 1.9; p < 0.01), tracheotomy (OR = 4.7; p < 0.01), or central venous catheterization (OR = 3.1; p < 0.01). Organisms commonly associated with HAP were Acinetobacter baumanii (41.5%), Pseudomonas aeruginosa (27.9%), and Klebsiella pneumoniae (9.5%). Hospital stay and extra hospitalization costs for patients with HAP (26.6 days, 50.1 million dong) were significantly higher compared with patients who did not acquire HAP (11.5 days, 23.4 million dong). The crude mortality rate for HAP patients was significantly higher than the mortality in the control group (84/172 [48.8%] vs. 65/172 [37.8%], p <0.05%).
Conclusion: we demonstrated a high incidence of HAP and significant attributable mortality among patients admitted to the largest hospital in Vietnam. Also, we showed substantial financial burden associated with HAP in a country with limited resources. Since the identified risk factors for HAP at BMH are largely associated with mechanical ventilation, upper airway management, and gram-negative bacteria with a proclivity for moisture, it is likely that infection control practices that focus on this area in addition to reducing ventilator-days will improve patient outcomes and reduce the high hospital costs.
Truong Anh Thu, MD, MPH1, Lennox Archibald, MD, PhD2, Nguyen Gia Binh, MD, PhD1, Nguyen Viet Hung, MD, PhD1 and  N. Viet Hung, None..
N. Gia Binh, None..
T. Anh Thu, None. 
L. K. Archibald,
RTI Biologics Role(s): Other, Medical Director, Received: Salary., (1)Bach Mai Hospital, Hanoi, Viet Nam, (2)College of Medicine, University of Florida, Gainesville, FL