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Microbiology of Surgical Site Infections and Associated Antimicrobial Use Among Vietnamese Orthopedic and Neurosurgical Patients

Published online by Cambridge University Press:  21 June 2016

Le Thi Anh Thu*
Infection Control Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
Annette H. Sohn
Division of Pediatric Infectious Diseases, University of California, San Francisco
Nguyen Phuc Tien
Infection Control Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
Vo Thi Chi Mai
Infection Control Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
Vo Van Nho
Infection Control Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
Tran Nguyen Trinh Hanh
Infection Control Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
Ben Ewald
Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, New South Wales, Australia
Michael Dibley
Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, New South Wales, Australia
Infection Control Department, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam, (



To determine the pathogens associated with surgical site infections (SSIs) and describe patterns of antimicrobial use and resistance in orthopedic and neurosurgical patients in a large university hospital in Vietnam.


Prospective cohort study.


Cho Ray Hospital, Ho Chi Minh City, Vietnam.


All patients who had operations during a 5-week study period.


Of 702 surgical patients, 80 (11.4%) developed an SSI. The incidence of SSI among orthopedic patients was 15.2% (48 of 315), and among neurosurgical patients it was 8.3% (32 of 387). Postoperative bacterial cultures of samples from the surgical sites were performed for 55 (68.8%) of the 80 patients with SSI; 68 wound swab specimens and 10 cerebrospinal fluid samples were cultured. Of these 78 cultures, 60 (76.9%) were positive for a pathogen, and 15 (25%) of those 60 cultures yielded multiple pathogens. The 3 most frequently isolated pathogens were Pseudomonas aeruginosa (29.5% of isolates), Staphylococcus aureus (11.5% of isolates), and Escherichia coli (10.3% of isolates). Ninety percent of S. aureus isolates were methicillin resistant, 91% of P. aeruginosa isolates were ceftazidime resistant, and 38% of E. coli isolates were cefotaxime resistant. All but 1 of the 702 patients received antimicrobial therapy after surgery, and the median duration of antimicrobial therapy was 11 days. Commonly used antimicrobials included aminopenicillins and second- and third-generation cephalosporins. Two or, more agents were given to 634 (90%) of the patients, and most combination drug regimens (86%) included an aminoglycoside.


Our data indicate that the incidence of SSI is high in our study population, that the main pathogens causing SSI are gram-negative bacteria and are often resistant to commonly used antimicrobials, that the use of broad-spectrum antimicrobials after surgery is widespread, and that implementation of interventions aimed at promoting appropriate and evidence-based use of antimicrobials are needed in Vietnam.

Original Articles
Copyright © The Society for Healthcare Epidemiology of America 2006

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1. Astagneau, P, Goliot, F, Brucker, G. Morbidity and mortality associated with SSIs: results from the 1997-1999 INCISO surveillance. J Hosp Infect 2001; 48:267274.Google Scholar
2. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance system report: data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 2001; 29:404421.Google Scholar
3. Kluytmans, J, Voss, A. Prevention of postsurgical infections: some like it hot. Curr Opin Infect Dis 2002; 15:427432.Google Scholar
4. Rapp, RP. Overview of resistant gram-positive pathogens in the surgical patient. Surg Infect Larchmt 2000; 1:3947.Google Scholar
5. Jarvis, WR, Martone, WJ. Predominant pathogens in hospital infections. J Antimicrob Chemother 1992; 29(Suppl A): 1924.Google Scholar
6. Gould, D, Chamberlain, A. Gram-negative bacteria: the challenge of preventing cross-infection in hospital wards: a review of the literature. J Clin Nurs 1994; 3:339345.Google Scholar
7. Ministry of Health of Viet Nam. Report of national prevalence of nosocomial infection. 1998.Google Scholar
8. Sohn, AH, Parvez, F, Vu, T, et al. Prevalence of surgical site infections in a large tertiary-care hospital, Ho Chi Minh City, Vietnam. Infect Control Hosp Epidemiol 2002; 23:382387.Google Scholar
9. Mangram, AJ, Horan, TC, Pearson, MI, Silver, LC, Jarvis, WR, the Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20:250278.CrossRefGoogle ScholarPubMed
10. National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Disk Susceptibility Tests. 6th ed. Approved standard. Wayne, PA: NCCLS; 1997. NCCLS document M2-A6.Google Scholar
11. Raggueneau, J, Cophignon, J, Kind, A, et al. Analysis of infectious sequelae of 1000 neurosurgical operations: effects of prophylactic antibiotherapy. Neurochirurgie 1983; 29:229233.Google Scholar
12. Korinek, AM. Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. Neurosurgery 1997;41:10731081.Google Scholar
13. Vernet, E, Adell, C, Trilla, A, et al. Usefulness of risk indexes for the prediction of surgical site infection in patient undergoing neurosurgical procedures. Medicina Clinica 2004; 122:9295.Google Scholar
14. Lecuire, F, Gontier, D, Carrere, J, Giordano, N, Rubini, J, Basso, M. Ten year surveillance of nosocomial surgical site infections in an orthopedic surgery department. Rev Chir Orthop Reparatrice Appar Mot 2003; 89: 479486.Google Scholar
15. Erisken, H, Chugulu, S, Kondo, S, Lingaas, E. Surgical site infections at Kilimanjaro Christian Medical center. J Hosp Infect 2003; 55:1420.Google Scholar
16. Patir, R, Mahapatra, AK, Banerji, AK. Risk factors in postoperative neurosurgical infection: a prospective study. Acta Neurochir Wien 1992; 119: 8084.CrossRefGoogle ScholarPubMed
17. Pories, S, Gamelli, R, Mead, P, Goodwin, G, Harris, F, Vacek, P. The epidemiologic features of nosocomial infections in patients with trauma. Arch Surg 1991; 126:9799.Google Scholar
18. Police Department of Ho Chi Minh City. Report of the motor related transport accidence in 5 years (1997-2002). Paper presented at: Viet Nam National Conference on the Situation of Motor-Related Transport Accidents and Methods of Resolution. 2002.Google Scholar
19. De Bels, D, Korineck, A, Bismuth, R, Trystram, D, Coriat, P, Puybasset, L. Empirical treatment of adult postsurgical nosocomial meningitis. Acta Neurochir Wien 2002; 144:989995.Google Scholar
20. Taylor, G, Bannister, G, Calder, S. Perioperative wound infection in elective orthopaedic surgery. J Hosp Infect 1990; 16:241247.CrossRefGoogle ScholarPubMed
21. Thanni, L, Osinupebi, O, Deji-Agboola, M. Prevalence of bacteria pathogens in infected wounds in a tertiary hospital, 1995-2001: any change in trend? J Natl Med Assoc 2003; 95:11891195.Google Scholar
22. Liassine, N. Problems of antibiotic-resistance gram negative pathogens in the hospital environment. Schweiz Med Wochenschr 2000; 130:19301936.Google ScholarPubMed
23. Quinn, JP. Clinical problems posed by multiresistant nonfermenting gram-negative pathogens. Clin Infect Dis 1998; 27:S117S124.Google Scholar
24. Hammond, C, Gill, J, Peto, T, Cadoux-Hudson, T, Bowler, I. Investigation of prevalence of MRSA in referrals to neurosurgery: implications for antibiotic prophylaxis. Br J Neurosurg 2002; 16:550554.Google Scholar
25. Vo, TCM. Theo doi muc do khang thuoc in vitro o benh vien Cho Ray nam 1997. Benh Vien Cho Ray-Tai Lieu Lam Sang Chon Loc 1999; 23: 8991.Google Scholar
26. Vo, TCM, Nguyen, VL, Nguyen, MT. Distinctive resistance of five common bacteria causing community-acquired and nosocomial infections. J Med Ho Chi Minh City 2002; 6:540546.Google Scholar
27. Therapeutic Guidelines: Antibiotic, version 12. North Melbourne, Australia: Therapeutic Guideline Ltd.; 2003. Available at: = 41. Accessed July 20, 2006.Google Scholar
28. Herruzo-Cabrera, R, Lopez-Gimenez, R, Diez-Sebastian, J, Lopez-Acinero, M-J, Banegas, JR. Surgical site infection of 7301 traumatologic inpatients (divided in two sub-cohorts, study and validation): modifiable determinants and potential benefits. Eur J Epidemiol 2004; 19:163169.CrossRefGoogle Scholar
29. Raymond, D, Pelletier, S, Crabtree, T, Evans, H, Pruette, T, Sawyer, R. Impact of antibiotic-resistant gram negative bacilli infections on outcome in hospitalised patients. Crit Care Med 2003; 31:10351041.CrossRefGoogle Scholar
30. Engemann, J, Carmeli, Y, Cosgrove, S, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003; 36:592598.Google Scholar