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Suntornsut P, Asadinia KS, Limato R, Tamara A, Rotty LWA, Bramanti R, Nusantara DU, Nelwan EJ, Khusuwan S, Suphamongkholchaikul W, Chamnan P, Piyaphanee W, Vu HTL, Nguyen YH, Nguyen KH, Pham TN, Le QM, Vu VH, Chau DM, Vo DETH, Harriss EK, van Doorn HR, Hamers RL, Lorencatto F, Atkins L, Limmathurotsakul D. Barriers and enablers to blood culture sampling in Indonesia, Thailand and Viet Nam: a Theoretical Domains Framework-based survey. BMJ Open 2024; 14:e075526. [PMID: 38373855 PMCID: PMC10882306 DOI: 10.1136/bmjopen-2023-075526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE Blood culture (BC) sampling is recommended for all suspected sepsis patients prior to antibiotic administration. We examine barriers and enablers to BC sampling in three Southeast Asian countries. DESIGN A Theoretical Domains Framework (TDF)-based survey, comprising a case scenario of a patient presenting with community-acquired sepsis and all 14 TDF domains of barriers/enablers to BC sampling. SETTING Hospitals in Indonesia, Thailand and Viet Nam, December 2021 to 30 April 2022. PARTICIPANTS 1070 medical doctors and 238 final-year medical students were participated in this study. Half of the respondents were women (n=680, 52%) and most worked in governmental hospitals (n=980, 75.4%). OUTCOME MEASURES Barriers and enablers to BC sampling. RESULTS The proportion of respondents who answered that they would definitely take BC in the case scenario was highest at 89.8% (273/304) in Thailand, followed by 50.5% (252/499) in Viet Nam and 31.3% (157/501) in Indonesia (p<0.001). Barriers/enablers in nine TDF domains were considered key in influencing BC sampling, including 'priority of BC (TDF-goals)', 'perception about their role to order or initiate an order for BC (TDF-social professional role and identity)', 'perception that BC is helpful (TDF-beliefs about consequences)', 'intention to follow guidelines (TDF-intention)', 'awareness of guidelines (TDF-knowledge)', 'norms of BC sampling (TDF-social influence)', 'consequences that discourage BC sampling (TDF-reinforcement)', 'perceived cost-effectiveness of BC (TDF-environmental context and resources)' and 'regulation on cost reimbursement (TDF-behavioural regulation)'. There was substantial heterogeneity between the countries. In most domains, the lower (higher) proportion of Thai respondents experienced the barriers (enablers) compared with that of Indonesian and Vietnamese respondents. A range of suggested intervention types and policy options was identified. CONCLUSIONS Barriers and enablers to BC sampling are varied and heterogenous. Cost-related barriers are more common in more resource-limited countries, while many barriers are not directly related to cost. Context-specific multifaceted interventions at both hospital and policy levels are required to improve diagnostic stewardship practices.
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Affiliation(s)
- Pornpan Suntornsut
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Koe Stella Asadinia
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ralalicia Limato
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Alice Tamara
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | | | - Erni J Nelwan
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | | | | | - Watcharapong Piyaphanee
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Yen Hai Nguyen
- Oxford University Clinical Research Unit, Ha Noi, Viet Nam
| | | | | | | | | | | | | | - Elinor K Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Hindrik Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
- Oxford University Clinical Research Unit, Ha Noi, Viet Nam
| | - Raph Leonardus Hamers
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | | | - Lou Atkins
- Centre for Behaviour Change, University College London, London, UK
| | - Direk Limmathurotsakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Varadan SR, Chandler CIR, Weed K, Ahmed SM, Atuire C, Batheja D, Bull SJ, Chan S, van Doorn HR, Giri A, Gerrets R, Hinchliffe S, Ho C, Imbach P, Joubert M, Kirchhelle C, Milfont TL, Molyneux S, Mutua EN, Pell C, Qekwana N, Mo Y, Cheah PY, Lewycka S. A just transition for antimicrobial resistance: planning for an equitable and sustainable future with antimicrobial resistance. Lancet 2023:S0140-6736(23)01687-2. [PMID: 37696277 DOI: 10.1016/s0140-6736(23)01687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/10/2023] [Indexed: 09/13/2023]
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Pham MH, Hoi LT, Beale MA, Khokhar FA, Hoa NT, Musicha P, Blackwell GA, Long HB, Huong DT, Binh NG, Co DX, Giang T, Bui C, Tran HN, Bryan J, Herrick A, Feltwell T, Nadjm B, Parkhill J, van Doorn HR, Trung NV, Van Kinh N, Török ME, Thomson NR. Evidence of widespread endemic populations of highly multidrug resistant Klebsiella pneumoniae in hospital settings in Hanoi, Vietnam: a prospective cohort study. Lancet Microbe 2023; 4:e255-e263. [PMID: 36801013 DOI: 10.1016/s2666-5247(22)00338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 09/14/2022] [Accepted: 11/16/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Patients with prolonged hospitalisation have a significant risk of carriage of and subsequent infection with extended spectrum β-lactamase (ESBL)-producing and carbapenemase-producing Klebsiella pneumoniae. However, the distinctive roles of the community and hospital environments in the transmission of ESBL-producing or carbapenemase-producing K pneumoniae remain elusive. We aimed to investigate the prevalence and transmission of K pneumoniae within and between the two tertiary hospitals in Hanoi, Viet Nam, using whole-genome sequencing. METHODS We did a prospective cohort study of 69 patients in intensive care units (ICUs) from two hospitals in Hanoi, Viet Nam. Patients were included if they were aged 18 years or older, admitted for longer than the mean length of stay in their ICU, and cultured K pneumoniae from their clinical samples. Longitudinally collected samples from patients (collected weekly) and the ICU environment (collected monthly) were cultured on selective media, and whole-genome sequences from K pneumoniae colonies analysed. We did phylogenetic analyses and correlated phenotypic antimicrobial susceptibility testing with genotypic features of K pneumoniae isolates. We constructed transmission networks of patient samples, relating ICU admission times and locations with genetic similarity of infecting K pneumoniae. FINDINGS Between June 1, 2017, and Jan 31, 2018, 69 patients were in the ICUs and eligible for inclusion, and a total of 357 K pneumoniae isolates were cultured and successfully sequenced. 228 (64%) of K pneumoniae isolates carried between two and four different ESBL-encoding and carbapenemase-encoding genes, with 164 (46%) isolates carrying genes encoding both, with high minimum inhibitory concentrations. We found a novel co-occurrence of blaKPC-2 and blaNDM-1 in 46·6% of samples from the globally successful ST15 lineage. Despite being physically and clinically separated, the two hospitals shared closely related strains carrying the same array of antimicrobial resistance genes. INTERPRETATION These results highlight the high prevalence of ESBL-positive carbapenem-resistant K pneumoniae in ICUs in Viet Nam. Through studying K pneumoniae ST15 in detail, we showed how important resistance genes are contained within these strains that are carried broadly by patients entering the two hospitals directly or through referral. FUNDING Medical Research Council Newton Fund, Ministry of Science and Technology, Wellcome Trust, Academy of Medical Sciences, Health Foundation, and National Institute for Health and Care Research Cambridge Biomedical Research Centre.
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Affiliation(s)
- My H Pham
- Wellcome Sanger Institute, Hinxton, UK; Oxford University Clinical Research Unit, Hanoi, Viet Nam
| | - Le Thi Hoi
- National Hospital for Tropical Diseases, Hanoi, Viet Nam; Hanoi Medical University, Hanoi, Viet Nam
| | | | - Fahad A Khokhar
- Department of Medicine, University of Cambridge, Cambridge, UK; Cambridge Institute for Therapeutic Immunology and Infectious Disease, Cambridge, UK
| | - Nguyen Thi Hoa
- National Hospital for Tropical Diseases, Hanoi, Viet Nam; National Lung Hospital, Department of Microbiology and National Tuberculosis Reference Laboratory, Hanoi, Viet Nam
| | | | - Grace A Blackwell
- Wellcome Sanger Institute, Hinxton, UK; EMBL-EBI, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Hoang Bao Long
- Oxford University Clinical Research Unit, Hanoi, Viet Nam
| | - Dang Thi Huong
- National Hospital for Tropical Diseases, Hanoi, Viet Nam
| | | | | | - Tran Giang
- National Hospital for Tropical Diseases, Hanoi, Viet Nam
| | | | - Hai Ninh Tran
- National Hospital for Tropical Diseases, Hanoi, Viet Nam
| | - James Bryan
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Archie Herrick
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Behzad Nadjm
- Oxford University Clinical Research Unit, Hanoi, Viet Nam; MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Julian Parkhill
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Hindrik Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Viet Nam; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nguyen Vu Trung
- National Hospital for Tropical Diseases, Hanoi, Viet Nam; Hanoi Medical University, Hanoi, Viet Nam
| | | | - Mili Estée Török
- Department of Medicine, University of Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Nicholas R Thomson
- Wellcome Sanger Institute, Hinxton, UK; London School of Hygiene and Tropical Medicine, London, UK
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