Abstract
ObjectiveTo analyse data from 2016–17 from a hospital-based antimicrobial resistance surveillance with national coverage in a network of hospitals Viet Nam.MethodsWe analysed data from 13 hospitals, 3 less than the dataset from the 2012–13 period. Identification and antimicrobial susceptibility testing data from the clinical microbiology laboratories from samples sent in for routine diagnostics were used. Clinical and Laboratory Standards Institute 2018 guidelines were used for antimicrobial susceptibility testing interpretation. WHONET was used for data entry, management and analysis.Results42,553 deduplicated isolates were included in this analysis; including 30,222 (71%) Gram-negative and 12,331 (29%) Gram-positive bacteria. 8,793 (21%) were from ICUs and 7,439 (18%) isolates were from invasive infections. Escherichia coli and Staphylococcus aureus were the most frequently detected species with 9,092 (21%) and 4,833 isolates (11%), respectively; followed by Klebsiella pneumoniae (3,858 isolates – 9.1%) and Acinetobacter baumannii (3,870 isolates – 9%). Bacteria were mainly isolated from sputum (8,798 isolates – 21%), blood (7,118 isolates – 17%) and urine (5,202 isolates – 12%). Among Gram-positives 3,302/4,515 isolates (73%) of S. aureus were MRSA; 99/290 (34%) of Enterococcus faecium were resistant to vancomycin; and 58% (663/1,136) of Streptococcus pneumoniae proportion were reduced susceptible to penicillin. Among Gram-negatives 59% (4,085/6,953) and 40% (1,186/2,958) of E. coli and K. pneumoniae produced ESBL and 29% (376/1,298) and 11% (961/8,830) were resistant to carbapenems, respectively. 79% (2855/3622) and 45% (1,514/3,376) of Acinetobacter spp. and Pseudomonas aeruginosa were carbapenem resistant, respectively. 88% (804/911) of Haemophilus influenzae were ampicillin resistant and 18/253 (7%) of Salmonella spp. and 7/46 (15%) of Shigella spp. were resistant to fluoroquinolones. The number of isolates from which data were submitted in the 2016–2017 period was twice as high as in 2012–2013. AMR proportions were higher in 2016–2017 for most pathogen-antimicrobial combinations of interest including imipenem-resistant A. baumannii, P. aeruginosa and Enterobacterales.ConclusionsThe data show alarmingly high and increasing resistant proportions among important organisms in Viet Nam. AMR proportions varied across hospital types and should be interpreted with caution because existing sampling bias and missing information on whether isolates were community or hospital acquired. Affordable and scalable ways to adopt a sample- or case-based approach across the network should be explored and clinical data should be integrated to help provide more accurate inferences of the surveillance data.
Highlights
In a 2015 estimate based on data from the European Antimicrobial Resistance Surveillance Network (EARSNet), over 33,000 people die each year in the European Union as a direct consequence of drug resistant infections [1]
Bacteria were mainly isolated from sputum (8,798 isolates – 21%), blood (7,118 isolates – 17%) and urine (5,202 isolates – 12%); 321 isolates (1%) were from cerebrospinal fluid (CSF)
We found a decrease of K. pneumoniae Multidrug Resistant (MDR) in VINARES 2016–2017
Summary
In a 2015 estimate based on data from the European Antimicrobial Resistance Surveillance Network (EARSNet), over 33,000 (out of 445 million inhabitants) people die each year in the European Union as a direct consequence of drug resistant infections [1]. Data from low- and middle-income countries (LMICs) are rare, but a recent paper from Thailand – with a population of 69 million – estimated that 19,122 of 45,209 (43%) deaths in patients with hospital-acquired infections are due to drug resistant infections. This higher number of deaths per capita attributable to AMR in Thailand in comparison with the EU suggests the burden of AMR in LMICs may be higher [2]. GLASS aims to enable standardized, comparable and validated AMR data collection and analysis and sharing of AMR data across countries to inform decision-making and action [6]
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