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Metrailer MC, Hoang TTH, Jiranantasak T, Luong T, Hoa LM, Ngoc DB, Pham QT, Pham VK, Hung TTM, Huong VTL, Pham TL, Ponciano JM, Hamerlinck G, Dang DA, Norris MH, Blackburn JK. Spatial and phylogenetic patterns reveal hidden infection sources of Bacillus anthracis in an anthrax outbreak in Son La province, Vietnam. Infect Genet Evol 2023; 114:105496. [PMID: 37678701 DOI: 10.1016/j.meegid.2023.105496] [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] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
Bacillus anthracis, the bacterial cause of anthrax, is a zoonosis affecting livestock and wildlife often spilling over into humans. In Vietnam, anthrax has been nationally reportable since 2015 with cases occurring annually, mostly in the northern provinces. In April 2022, an outbreak was reported in Son La province following the butchering of a water buffalo, Bubalus bubalis. A total of 137 humans from three villages were likely exposed to contaminated meat from the animal. Early epidemiological investigations suggested a single animal was involved in all exposures. Five B. anthracis isolates were recovered from human clinical cases along with one from the buffalo hide, another from associated maggots, and one from soil at the carcass site. The isolates were whole genome sequenced, allowing global, regional, and local molecular epidemiological analyses of the outbreak strains. All recovered B. anthracis belong to the A.Br.001/002 lineage based on canonical single nucleotide polymorphism analysis (canSNP). Although not previously identified in Vietnam, this lineage has been identified in the nearby countries of China, India, Indonesia, Thailand, as well as Australia. A twenty-five marker multi-locus variable number tandem repeat analysis (MLVA-25) was used to investigate the relationship between human, soil, and buffalo strains. Locally, four MLVA-25 genotypes were identified from the eight isolates. This level of genetic diversity is unusual for the limited geography and timing of cases and differs from past literature using MLVA-25. The coupled spatial and phylogenetic data suggest this outbreak originated from multiple, likely undetected, animal sources. These findings were further supported by local news reports that identified at least two additional buffalo deaths beyond the initial animal sampled in response to the human cases. Future outbreak response should include intensive surveillance for additional animal cases and additional molecular epidemiological traceback to identify pathogen sources.
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Affiliation(s)
- Morgan C Metrailer
- Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | | | - Treenate Jiranantasak
- Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Tan Luong
- Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Luong Minh Hoa
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Do Bich Ngoc
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Quang Thai Pham
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Van Khang Pham
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | | | | | | | | | | | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Michael H Norris
- Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Jason K Blackburn
- Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
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Ngan TTD, Quan TA, Quang LM, Vinh VH, Duc CM, Nguyet HT, Tu NTC, Khanh NH, Long LB, Hue NH, Hung DT, Thanh ND, Ve NV, Giang TT, Tung LT, Tuan TT, Kesteman T, Dodds Ashley E, Anderson DJ, Van Doorn HR, Huong VTL. Review of antibiotic prescriptions as part of antimicrobial stewardship programmes: results from a pilot implementation at two provincial-level hospitals in Viet Nam. JAC Antimicrob Resist 2023; 5:dlac144. [PMID: 36686271 PMCID: PMC9847554 DOI: 10.1093/jacamr/dlac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives To investigate the feasibility of retrospective prescription-based review and to describe the antibiotic prescribing patterns to provide information for an antimicrobial stewardship programme in Viet Nam. Methods This study was conducted in two provincial-level hospitals between February and April 2020. Reviews were done by a clinical team consisting of leaders/senior doctors of each ward to assess the optimal level (optimal/adequate/suboptimal/inadequate/not assessable) of antibiotic prescriptions. Mixed-effect logistic regression at prescription level was used to explore factors associated with optimal antibiotic use. Results The retrospective prescription-based review was accepted by study clinical wards with varied levels of participants. One hundred and eighty-three patients (326 prescriptions) in Hospital 1 and 200 patients (344 prescriptions) in Hospital 2 were included. One hundred and nineteen of the 326 (36.5%) antibiotic prescriptions in Hospital 1 and 51/344 (14.8%) antibiotic prescriptions in Hospital 2 were determined to be optimal by the review teams. The number of adequate antibiotic prescriptions were 179/326 (54.9%) and 178 (51.7%) in Hospital 1 and Hospital 2, respectively. The optimal level was lower for surgical prophylaxis antibiotics than for empirical therapy (OR = 0.06; 95% CI 0.01-0.45), higher in prescriptions in the ICU (OR = 12.00; 95% CI 3.52-40.92), higher in definitive antibiotic therapy (OR = 48.12; 95% CI 7.17-322.57) and higher in those with an indication recorded in medical records (OR = 3.46; 95% CI 1.13-10.62). Conclusions This study provides evidence on the feasibility of retrospective prescription-based review, with adaption to the local situation. High and varying levels of optimal antibiotic prescriptions in clinical wards in hospitals were observed in Viet Nam.
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Affiliation(s)
| | | | - Le Minh Quang
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Vu Hai Vinh
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Chau Minh Duc
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Huynh Thi Nguyet
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Nguyen Thi Cam Tu
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
| | - Nguyen Hong Khanh
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
| | - Le Ba Long
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Nguyen Hong Hue
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Dinh The Hung
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Nguyen Duc Thanh
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Nguyen Van Ve
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Tran Thanh Giang
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Le Thanh Tung
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Truong Thanh Tuan
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Thomas Kesteman
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
| | - Elizabeth Dodds Ashley
- Duke Antimicrobial Stewardship Outreach Network, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, NC 27710, USA
| | - Deverick J Anderson
- Duke Antimicrobial Stewardship Outreach Network, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, NC 27710, USA
| | - H Rogier Van Doorn
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Vu Thi Lan Huong
- Corresponding author. E-mail: @Quan_Truong_Anh, @Nguyencamtu, @hrogier, @Deverick_A, @HuongVu03531589, @The_Real_LDA
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Roberts T, Dahal P, Shrestha P, Schilling W, Shrestha R, Ngu R, Huong VTL, van Doorn HR, Phimolsarnnousith V, Miliya T, Crump JA, Bell D, Newton PN, Dittrich S, Hopkins H, Stepniewska K, Guerin PJ, Ashley EA, Turner P. Antimicrobial resistance patterns in bacteria causing febrile illness in Africa, South Asia, and Southeast Asia: a systematic review of published etiological studies from 1980-2015. Int J Infect Dis 2022; 122:612-621. [PMID: 35817284 DOI: 10.1016/j.ijid.2022.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In this study, we aimed to conduct a systematic review to characterize antimicrobial resistance (AMR) patterns for bacterial causes of febrile illness in Africa and Asia. METHODS We included published literature from 1980-2015 based on data extracted from two recent systematic reviews of nonmalarial febrile illness from Africa, South Asia, and Southeast Asia. Selection criteria included articles with full bacterial identification and antimicrobial susceptibility testing (AST) results for key normally sterile site pathogen-drug combinations. Pooled proportions of resistant isolates were combined using random effects meta-analysis. Study data quality was graded using the Microbiology Investigation Criteria for Reporting Objectively (MICRO) framework. RESULTS Of 3475 unique articles included in the previous reviews, 371 included the target pathogen-drug combinations. Salmonella enterica tested against ceftriaxone and ciprofloxacin were the two highest reported combinations (30,509 and 22,056 isolates, respectively). Pooled proportions of resistant isolates were high for third-generation cephalosporins for Klebsiella pneumoniae and Escherichia coli in all regions. The MICRO grading showed an overall lack of standardization. CONCLUSION This review highlights a general increase in AMR reporting and in resistance over time. However, there were substantial problems with diagnostic microbiological data quality. Urgent strengthening of laboratory capacity, standardized testing, and reporting of AST results is required to improve AMR surveillance.
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Affiliation(s)
- Tamalee Roberts
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Prabin Dahal
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Infectious Diseases Data Observatory (IDDO), University of Oxford, Old Road Campus, Oxford, UK
| | - Poojan Shrestha
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Infectious Diseases Data Observatory (IDDO), University of Oxford, Old Road Campus, Oxford, UK
| | - William Schilling
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rujan Shrestha
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Old Road Campus, Oxford, UK
| | - Roland Ngu
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Old Road Campus, Oxford, UK
| | | | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Clinical Research Unit (OUCRU), Vietnam
| | - Vilayouth Phimolsarnnousith
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Thyl Miliya
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - John A Crump
- Centre for International Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - David Bell
- Independent consultant, Issaquah, WA, USA
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Infectious Diseases Data Observatory (IDDO), University of Oxford, Old Road Campus, Oxford, UK; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sabine Dittrich
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Heidi Hopkins
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Kasia Stepniewska
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Infectious Diseases Data Observatory (IDDO), University of Oxford, Old Road Campus, Oxford, UK
| | - Philippe J Guerin
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Infectious Diseases Data Observatory (IDDO), University of Oxford, Old Road Campus, Oxford, UK
| | - Elizabeth A Ashley
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
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Huong VTL, Ngan TTD, Thao HP, Tu NTC, Quan TA, Nadjm B, Kesteman T, Kinh NV, van Doorn HR. Improving antimicrobial use through antimicrobial stewardship in a lower-middle income setting: a mixed-methods study in a network of acute-care hospitals in Viet Nam. J Glob Antimicrob Resist 2021; 27:212-221. [PMID: 34601183 PMCID: PMC8692234 DOI: 10.1016/j.jgar.2021.09.006] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial stewardship (AMS) in low- and middle-income settings has multiple players. Leadership commitment greatly influences AMS implementation in hospitals. Staff showed good perception of AMS but misperceptions on local resistance levels. Guidelines on staffing and training standards are needed to support implementation. More support is needed to promote active roles of pharmacists and microbiologists.
Objectives This study aimed to analyse the current state of antimicrobial stewardship (AMS) in hospitals in Viet Nam, a lower-middle income country (LMIC), to identify factors determining success in AMS implementation and associated challenges to inform planning and design of future programmes. Methods We conducted a mixed-methods study in seven acute-care hospitals in the antimicrobial resistance (AMR) surveillance network in Viet Nam. Data collection included 7 focus group discussions, 40 in-depth interviews and a self-administered quantitative survey of staff on AMR and AMS programmes. We summarised qualitative data by reporting the most common themes according to the core AMS elements, and analysed quantitative data using proportions and a linear mixed-effects model. Results The findings reveal a complex picture of factors and actors involved in AMS implementation from the national level to the departmental and individual level within each hospital. The level of implementation varied, starting from the formation of an AMS committee, with or without active delivery of specific interventions. Development of treatment guidelines, pre-authorisation of antimicrobial drug classes, and post-prescription audit and feedback to doctors in selected clinical departments were the main interventions reported. A higher level of leadership support and commitment to AMS led to a higher level of engagement with AMS activities from the AMS team and effective collaboration between departments involved. Conclusion Establishing country-specific guidelines on AMS staffing and adapting standards for AMS education and training from international resources are needed to support capacity building to implement AMS programmes effectively in LMICs such as Viet Nam.
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Affiliation(s)
- Vu Thi Lan Huong
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet Nam.
| | - Ta Thi Dieu Ngan
- National Hospital for Tropical Diseases, 78 Giai Phong, Hanoi, Viet Nam
| | - Huynh Phuong Thao
- Hospital for Tropical Diseases, 764 Vo Van Kiet, Ho Chi Minh City, Viet Nam
| | - Nguyen Thi Cam Tu
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet Nam
| | - Truong Anh Quan
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet Nam
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet Nam; MRC Unit The Gambia at The London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Thomas Kesteman
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet Nam
| | - Nguyen Van Kinh
- National Hospital for Tropical Diseases, 78 Giai Phong, Hanoi, Viet Nam
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Huong VTL, Ngan TTD, Thao HP, Quang LM, Hanh TTT, Hien NT, Duc T, Vinh VH, Duc CM, Dung Em VTH, Bay PVB, Oanh NTT, Hang PTT, Tu NTC, Quan TA, Kesteman T, Dodds Ashley E, Anderson D, van Doorn HR. Assessing feasibility of establishing antimicrobial stewardship programmes in two provincial-level hospitals in Vietnam: an implementation research study. BMJ Open 2021; 11:e053343. [PMID: 34598989 PMCID: PMC8488745 DOI: 10.1136/bmjopen-2021-053343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/01/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To investigate the feasibility of establishing hospital-based antimicrobial stewardship (AMS) programmes comprising action-planning, educational interventions and data feedback in two provincial-level hospitals in Viet Nam. DESIGN AND SETTING This was an implementation research using participatory action process and existing resources from the Duke Antimicrobial Stewardship Outreach Network with local adjustments. A national stakeholder meeting and Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis were conducted to identify gaps and potential interventions. PARTICIPANTS Hospital AMS staff implemented activities throughout the study phases. Routinely collected patient data were analysed to support planning, implementation and evaluation. INTERVENTIONS Hospitals were considered as a complex adaptive system and leveraged their unique characteristics and interconnections to develop 1-year plans containing core interventions (data use, educational training, prospective audit with feedback (PAF) and evaluations). OUTCOME MEASURES We assessed feasibility using outputs from stakeholder meeting, SWOT analysis, baseline data, planning process and implementation. RESULTS The stakeholder meeting identified three gaps for AMS at national level: supportive policies, AMS training and core competencies and collaboration. At the hospitals, AMS programmes took 1 year for planning due to lack of hospital-specific procedures and relevant staff competencies. Baseline data (January-December 2019) showed variations in antibiotic consumption: 951 days of therapy (DOT) per 1000 days present in the control and 496 in the intervention wards in hospital 1, and 737 and 714 in hospital 2, respectively. During 1-year implementation, clinical pharmacists audited 1890 antibiotic prescriptions in hospital 1 (June 2020-May 2021) and 1628 in hospital 2 (July 2020-July 2021), and will continue PAF in their daily work. CONCLUSION Our data confirmed the need to contextualise AMS programmes in low-income and middle-income countries (LMICs) and demonstrated the usefulness of implementation research design in assessing programme feasibility. Developing staff competencies, using local data to stimulate actions and integrating programme activities in routine hospital work are key to success in LMICs.
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Affiliation(s)
- Vu Thi Lan Huong
- Ha Noi Unit, Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | | | | | | | | | | | - Tran Duc
- Viet Tiep Hospital, Hai Phong, Vietnam
| | | | | | | | | | | | | | - Nguyen Thi Cam Tu
- Ha Noi Unit, Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | - Truong Anh Quan
- Ha Noi Unit, Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | - Thomas Kesteman
- Ha Noi Unit, Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | - Elizabeth Dodds Ashley
- Duke Antimicrobial Stewardship Outreach Network, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, North Carolina, USA
| | - Deverick Anderson
- Duke Antimicrobial Stewardship Outreach Network, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, North Carolina, USA
| | - H Rogier van Doorn
- Ha Noi Unit, Oxford University Clinical Research Unit, Ha Noi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Wertheim HFL, Huong VTL, Kuijper EJ. Clinical microbiology laboratories in low-resource settings, it is not only about equipment and reagents, but also good governance for sustainability. Clin Microbiol Infect 2021; 27:1389-1390. [PMID: 34332110 DOI: 10.1016/j.cmi.2021.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Heiman F L Wertheim
- Department of Medical Microbiology, Radboud UMC and Center for Infectious Diseases, Radboud UMC, Nijmegen, the Netherlands.
| | - Vu Thi Lan Huong
- Oxford University Clinical Research Unit, Dong Da, Hanoi, Viet Nam
| | - Ed J Kuijper
- Department of Medical Microbiology and Experimental Bacteriology, Leiden University Medical Center and RIVM, Leiden, the Netherlands
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Huong VTL, Turner HC, Kinh NV, Thai PQ, Hoa NT, Horby P, van Doorn HR, Wertheim HFL. Burden of disease and economic impact of human Streptococcus suis infection in Viet Nam. Trans R Soc Trop Med Hyg 2020; 113:341-350. [PMID: 30809669 PMCID: PMC6580695 DOI: 10.1093/trstmh/trz004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/24/2018] [Accepted: 01/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Streptococcus suis is a zoonotic disease mainly affecting men of working age and can result in death or long-term sequelae, including severe hearing loss and vestibular dysfunction. We aimed to quantify the burden of disease and economic impact of this infection in Viet Nam. METHODS The annual disease incidence for the period 2011-2014 was estimated based on surveillance data using a multiple imputation approach. We calculated disease burden in disability-adjusted life years (DALYs) and economic costs using an incidence-based approach from a patient's perspective and including direct and indirect impacts of S. suis infection and its long-term sequelae. RESULTS The estimated annual incidence rate was 0.318, 0.324, 0.255 and 0.249 cases per 100 000 population in 2011, 2012, 2013 and 2014, respectively. The corresponding DALYs lost were 1832, 1866, 1467 and 1437. The mean direct cost per episode was US$1635 (95% confidence interval 1352-1923). The annual direct cost was US$370 000-500 000 and the indirect cost was US$2.27-2.88 million in this time period. CONCLUSIONS This study showed a large disease burden and high economic impact of S. suis infection and provides important data for disease monitoring and control.
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Affiliation(s)
- Vu Thi Lan Huong
- Wellcome Trust Asia Programme-Oxford University Clinical Research Unit, 78 Giai Phong, Dong Da, Ha Noi, Viet Nam
| | - Hugo C Turner
- Wellcome Trust Asia Programme-Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh, Viet Nam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road campus, Roosevelt Drive, Headington, Oxford, UK
| | - Nguyen Van Kinh
- National Hospital for Tropical Diseases, 78 Giai Phong, Dong Da, Hanoi, Viet Nam
| | - Pham Quang Thai
- National Institute for Hygiene and Epidemiology, 131 Lo Duc, Hai Ba Trung, Hanoi, Viet Nam
| | - Ngo Thi Hoa
- Wellcome Trust Asia Programme-Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh, Viet Nam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road campus, Roosevelt Drive, Headington, Oxford, UK
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road campus, Roosevelt Drive, Headington, Oxford, UK
| | - H Rogier van Doorn
- Wellcome Trust Asia Programme-Oxford University Clinical Research Unit, 78 Giai Phong, Dong Da, Ha Noi, Viet Nam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road campus, Roosevelt Drive, Headington, Oxford, UK
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Anh DD, Choisy M, Clapham HE, Cuong HQ, Dung VTV, Duong TN, Hang NLK, Ha HTT, Hien NT, Hoa TTN, Hung TTM, Huong VTL, Huyen DTT, Khanh NC, Lewycka SO, Linley E, Mai LTQ, Nadjm B, Nghia ND, Pebody R, Phuong HVM, Tan LM, Van Tan L, Thai PQ, Thanh LV, Le Thanh NT, Thuy NTT, Thuong NT, Thanh LT, Thao NTT, Tuan NA, Uyen PTN, Rogier van Doorn H. Plans for Nationwide Serosurveillance Network in Vietnam. Emerg Infect Dis 2019; 26. [PMID: 31855527 PMCID: PMC6924907 DOI: 10.3201/eid2601.190641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In recent years, serosurveillance has gained momentum as a way of determining disease transmission and immunity in populations, particularly with respect to vaccine-preventable diseases. At the end of 2017, the Oxford University Clinical Research Unit and the National Institute of Hygiene and Epidemiology held a meeting in Vietnam with national policy makers, researchers, and international experts to discuss current seroepidemiologic projects in Vietnam and future needs and plans for nationwide serosurveillance. This report summarizes the meeting and the plans that were discussed to set up nationwide serosurveillance in Vietnam.
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Bonell A, Azarrafiy R, Huong VTL, Viet TL, Phu VD, Dat VQ, Wertheim H, van Doorn HR, Lewycka S, Nadjm B. A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology. Clin Infect Dis 2019; 68:511-518. [PMID: 29982303 PMCID: PMC6336913 DOI: 10.1093/cid/ciy543] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/29/2018] [Indexed: 01/31/2023] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia. Methods We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level. Results Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%). Conclusions VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high.
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Affiliation(s)
- Ana Bonell
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | | | - Vu Thi Lan Huong
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Thanh Le Viet
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | | | | | - Heiman Wertheim
- Department of Medical Microbiology, Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - H Rogier van Doorn
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Sonia Lewycka
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Behzad Nadjm
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
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Dat VQ, Huong VTL, Turner HC, Thwaites L, van Doorn HR, Nadjm B. Correction: Excess direct hospital cost of treating adult patients with ventilator associated respiratory infection (VARI) in Vietnam. PLoS One 2018; 13:e0208361. [PMID: 30481224 PMCID: PMC6258565 DOI: 10.1371/journal.pone.0208361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0206760.].
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Dat VQ, Huong VTL, Turner HC, Thwaites L, van Doorn HR, Nadjm B. Excess direct hospital cost of treating adult patients with ventilator associated respiratory infection (VARI) in Vietnam. PLoS One 2018; 13:e0206760. [PMID: 30379956 PMCID: PMC6209379 DOI: 10.1371/journal.pone.0206760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/18/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction Ventilator associated respiratory infections (VARIs) are the most common hospital acquired infections in critical care worldwide. This work aims to estimate the total annual direct hospital cost of treating VARI throughout Vietnam. Methods A costing model was constructed to evaluate the excess cost of diagnostics and treatment of VARI in Vietnam. Model inputs included costs for extra lengths of stay, diagnostics, VARI incidence, utilisation of ventilators and antibiotic therapy. Results With the current VARI incidence rate of 21.7 episodes per 1000 ventilation-days, we estimated 34,428 VARI episodes in the 577 critical care units in Vietnam per year. The extra cost per VARI episode was $1,174.90 and the total annual excess cost was US$40.4 million. A 1% absolute reduction in VARI incidence density would save US$1.86 million annually. For each episode of VARI, the share of excess cost components was 45.1% for critical care unit stay and ventilation, 3.7% for diagnostics and 51.1% for extra antimicrobial treatment. Conclusions At the current annual government health expenditure of US$117 per capita, VARI represents a substantial cost to the health service in Vietnam. Enhanced infection prevention and control and antimicrobial stewardship programmes should be implemented to reduce this.
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Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- * E-mail: ,
| | - Vu Thi Lan Huong
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Hugo C. Turner
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Louise Thwaites
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - H. Rogier van Doorn
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Behzad Nadjm
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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Huong VTL, Hoa NT, Horby P, Bryant JE, Van Kinh N, Toan TK, Wertheim HFL. Raw pig blood consumption and potential risk for Streptococcus suis infection, Vietnam. Emerg Infect Dis 2015; 20:1895-8. [PMID: 25340391 PMCID: PMC4214319 DOI: 10.3201/eid2011.140915] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We assessed consumption of raw pig blood, which is a risk factor for Streptococcus suis infection in Vietnam, by using a mix-method design. Factors associated with consumption included rural residency, age, sex, occupation, income, and marital status. We identified risk groups and practices and perceptions that should be targeted by communication programs.
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Huong VTL, Ha N, Huy NT, Horby P, Nghia HDT, Thiem VD, Zhu X, Hoa NT, Hien TT, Zamora J, Schultsz C, Wertheim HFL, Hirayama K. Epidemiology, clinical manifestations, and outcomes of Streptococcus suis infection in humans. Emerg Infect Dis 2014; 20:1105-14. [PMID: 24959701 PMCID: PMC4073838 DOI: 10.3201/eid2007.131594] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Streptococcus suis, a bacterium that affects pigs, is a neglected pathogen that causes systemic disease in humans. We conducted a systematic review and meta-analysis to summarize global estimates of the epidemiology, clinical characteristics, and outcomes of this zoonosis. We searched main literature databases for all studies through December 2012 using the search term "streptococcus suis." The prevalence of S. suis infection is highest in Asia; the primary risk factors are occupational exposure and eating of contaminated food. The pooled proportions of case-patients with pig-related occupations and history of eating high-risk food were 38.1% and 37.3%, respectively. The main clinical syndrome was meningitis (pooled rate 68.0%), followed by sepsis, arthritis, endocarditis, and endophthalmitis. The pooled case-fatality rate was 12.8%. Sequelae included hearing loss (39.1%) and vestibular dysfunction (22.7%). Our analysis identified gaps in the literature, particularly in assessing risk factors and sequelae of this infection.
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Hoa NT, Chieu TTB, Do Dung S, Long NT, Hieu TQ, Luc NT, Nhuong PT, Huong VTL, Trinh DT, Wertheim HFL, Van Kinh N, Campbell JI, Farrar J, Chau NVV, Baker S, Bryant JE. Streptococcus suis and porcine reproductive and respiratory syndrome, Vietnam. Emerg Infect Dis 2013; 19:331-3. [PMID: 23343623 PMCID: PMC3559037 DOI: 10.3201/eid1902.120470] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Lan Huong VT, Malimas T, Yukphan P, Potacharoen W, Tanasupawat S, Thanh Loan LT, Tanticharoen M, Yamada Y. Identification of Thai isolates assigned to the genus Gluconobacter based on 16S-23S rDNA ITS restriction analysis. J GEN APPL MICROBIOL 2007; 53:133-42. [PMID: 17575453 DOI: 10.2323/jgam.53.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Forty-four Thai isolates phenotypically assigned to the genus Gluconobacter were examined for 16S-23S rDNA ITS restriction analysis by MboII and SduI (=Bsp1286I) digestions. The Thai isolates tested were divided into seven groups: Group I for fourteen isolates, Group IX for one isolate, Group X for two isolates, Group V-2 for four isolates, Group XI for three isolates, Group IV for one isolate, and Group III for nineteen isolates. There were no isolates of either Group II or Group V-1 that were identified as G. cerinus. The isolates of Group III, Group IV, and Group XI were subjected to an additional 16S-23S rDNA ITS restriction analysis by AvaII, TaqI, BsoBI, and BstNI digestions. The isolates of Group III were divided into three groups and two subgroups: Group III-2 for five isolates, Group III-6 for two isolates, and Group III-4, which was divided into two subgroups, Subgroup III-4a for four isolates and Subgroup III-4b for eight isolates. The fourteen isolates of Group I were identified as G. oxydans, and the two isolates of Group X were temporarily identified as G. oxydans. The five isolates of Group III-2 and the one isolate of Group IV were identified as G. frateurii. The remaining twenty-two isolates of Group V-2, Group III-4, Group III-6, Group IX, and Group XI were not identified but are candidates for several new species.
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Affiliation(s)
- Vu Thi Lan Huong
- BIOTEC Culture Collection, BIOTEC Central Research Unit, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathumthani 12120, Thailand
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Huong VTL, Malimas T, Yukphan P, Potacharoen W, Tanasupawat S, Loan LTT, Tanticharoen M, Yamada Y. Identification of Thai isolates assigned to the genus Asaia based on 16S rDNA restriction analysis. J GEN APPL MICROBIOL 2007; 53:259-64. [PMID: 17878666 DOI: 10.2323/jgam.53.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Vu Thi Lan Huong
- BIOTEC Culture Collection (BCC), BIOTEC Central Research Unit, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathumthani 12120, Thailand
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