Antimicrobial Resistance

Research into antimicrobial resistance at OUCRU Vietnam

Antimicrobial resistance is a major concern throughout the world. Since the introduction of penicillin, antibiotics have been used so widely that bacteria have adapted and are becoming more and more resistant to them. OUCRU’s research focuses on the following areas:

  • Emergence of antimicrobial resistance, looking at how and why antibiotic resistance is developing.
  • Preventing resistance to antimicrobials: working out how best to prevent resistance developing.
  • Alternative treatment options: to find the best treatment options for antimicrobial resistant infections.
  • The role of agriculture: to identify of the main drivers of antimicrobial use and resistance in animal production.

Antimicrobial resistance in Vietnam

  • Unregulated use of antibiotics is common in Vietnam. Antibiotics are often sold without a doctor’s prescription or even by a trained pharmacist. There is less regulation of marketing methods of pharmaceutical companies to prevent them giving selective information or material incentives to doctors and pharmacists.
  • Agricultural and non-medical use of antimicrobials is extensive. In poultry and pig productions antimicrobials are typically used to prevent rather than to treat clinical disease. Most commercial feed currently used for poultry and pig production is medicated with antibiotics. The amount of antimicrobials used to raise poultry is in the order of 5-7 times higher than in European countries.
  • We do not know the best way to prevent antibiotic resistance in countries such as Vietnam. We know very little about how and why resistance develops and most of our knowledge comes from Western countries, which may have very different reasons for resistance.

Our Work

  • OUCRU Vietnam conducts antimicrobial resistance research within two main centres : OUCRU Ha Noi and OUCRU Ho Chi Minh City. OUCRU is also part of a network of 16 hospitals throughout Vietnam providing important information on antimicrobial resistance and antibiotic use for Vietnamese doctors and policy makers.
  • We are conducting detailed studies on how antimicrobial resistance occurs looking at infections occurring in hospitalised patients and those treated in the community.
  • We are looking at ways of improving the diagnosis of simple infections in primary health care as this may reduce antibiotic overuse.
  • We are involved with developing national antimicrobial treatment guidelines.
  • We are advising the Ministry Of Health on a National Action Plan on Antimicrobial Resistance
  • Community projects studying pharmacy and prescribing practices to find ways of reducing unnecessary antibiotic use.
  • We are investigating the dynamics of antimicrobial resistance in pig and poultry farms. We are collecting data collecting data on antimicrobial use over the production cycle and are measuring the resistance present in commensal organisms in animals and the farm’s environment.

Our Antimicrobial Resistance researchers

  • Guy Thwaites
  • Stephen Baker
  • Louise Thwaites
  • James Campbell
  • Ngo Thi Hoa
  • Juan Carrique Mas
  • Behzad Nadjm
  • Rogier van Doorn

PHD Students

  • Do Thuy Nga, pharmacist. Nga works on strategies to reduce antibiotic use in Vietnam.
  • Vu Dinh Phu, doctor and head of ICU NHTD. Dr Phu works on hospital acquired infections on ICUs in Vietnam
  • Hoang Thi Thanh Thuy, doctor and coordinator national MDR TB program. Dr Thuy works on improving screening for MDR TB in Vietnam.
  • Duong Bich Thuy, doctor from ICU HTD. Dr Thuy is working why antimicrobial resistance occurs in ICU patients
  • Nguyen Vinh Trung, veterinarian, works to investigate antimicrobial use in poultry, antimicrobial resistance in Escherichia coli in poultry as well as farmers and other community referents.

Our research locations

OUCRU is based at the Hospital for Tropical Diseases in HCMC and the National Hospital of Tropical Diseases in Hanoi. In the area of antibiotic resistance we collaborate also with National Institute of Hygiene and Epidemiology (NIHE) and Hanoi Medical University (HMU).

Our collaborations/partnerships

  • Ministry of Health
  • National Hospital of Tropical Diseases
  • National Institute of Hygiene and Epidemiology
  • Hospital of Tropical Diseases
  • Hanoi Medical University
  • Global Antibiotic Resistance Partnership
  • VINARES network of 16 Vietnamese hospitals
  • Sub-department of Animal Health (Tien Giang)
  • Sub-Department of Animal Health (Dong Thap)
  • Regional Animal Health laboratory (RAHO) 5, Dak Lak

Key milestones

We recently completed a national program (VINARES) to assess hospital acquired infections, antibiotic use and antibiotic resistance in 16 hospitals across Vietnam. We had a closing meeting in October 2013 with 120 international participants in Hanoi.

OUCRU is close to all the key national institutes in Vietnam (see partners/collaborators) and the Ministry of Health. These relations ensure that our research findings also find their way into policies. Our research in the area of antibiotic resistance supported the development of a National Action Plan on Antibiotic Resistance that was signed by the minister of health mid 2013.

Publications

Nguyen KV, Thi Do NT, Chandna A, Nguyen TV, Pham CV, Doan PM, Nguyen AQ, Thi Nguyen CK, Larsson M, Escalante S, Olowokure B, Laxminarayan R, Gelband H, Horby P, Thi Ngo HB, Hoang MT, Farrar J, Hien TT, Wertheim HF. Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam. BMC Public Health. 2013 Dec 10;13:1158. doi: 10.1186/1471-2458-13-1158. PubMed PMID: 24325208.

Baker S, Duy PT, Nga TV, Dung TT, Phat VV, Chau TT, Turner AK, Farrar J, Boni MF. Fitness benefits in fluoroquinolone-resistant Salmonella Typhi in the absence of antimicrobial pressure. Elife. 2013 Dec 10;2:e01229. doi: 10.7554/eLife.01229. PubMed PMID: 24327559; PubMed Central PMCID: PMC3857714.

Nga do TT, Chuc NT, Hoa NP, Hoa NQ, Nguyen NT, Loan HT, Toan TK, Phuc HD, Horby P, Van Yen N, Van Kinh N, Wertheim HF. Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study. BMC Pharmacol Toxicol. 2014 Feb 20;15(1):6. doi: 10.1186/2050-6511-15-6. PubMed PMID: 24555709; PubMed Central PMCID: PMC3946644.

Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, Vlieghe E, Hara GL, Gould IM, Goossens H, Greko C, So AD, Bigdeli M, Tomson G, Woodhouse W, Ombaka E, Peralta AQ, Qamar FN, Mir F, Kariuki S, Bhutta ZA, Coates A, Bergstrom R, Wright GD, Brown ED, Cars O. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013 Dec;13(12):1057-98. doi:10.1016/S1473-3099(13)70318-9. Epub 2013 Nov 1.

Hoang TH, Wertheim H, Minh NB, Duong TN, Anh DD, Phuong TT, Son TH, Izumiya H, Ohnishi M, Shibayama K, Hien NT. Carbapenem-resistant Escherichia coli and Klebsiella pneumoniae strains containing New Delhi metallo-beta-lactamase isolated from two patients in Vietnam. J Clin Microbiol. 2013 Jan;51(1):373-4. doi: 10.1128/JCM.02322-12. Epub 2012 Oct 24. PubMed PMID: 23100353; PubMed Central PMCID: PMC3536186.

Wertheim HF, Chandna A, Vu PD, Pham CV, Nguyen PD, Lam YM, Nguyen CV, Larsson M, Rydell U, Nilsson LE, Farrar J, Nguyen KV, Hanberger H. Providing impetus, tools, and guidance to strengthen national capacity for antimicrobial stewardship in Viet Nam. PLoS Med. 2013;10(5):e1001429. doi: 10.1371/journal.pmed.1001429. Epub 2013 May 7. PubMed PMID: 23667342; PubMed Central PMCID: PMC3646721.

Tran HD, Alam M, Trung NV, Kinh NV, Nguyen HH, Pham VC, Ansaruzzaman M, Rashed SM, Bhuiyan NA, Dao TT, Endtz HP, Wertheim HF. Multi-drug resistant Vibrio cholerae O1 variant El Tor isolated in northern Vietnam between 2007 and 2010. J Med Microbiol. 2012 Mar;61(Pt 3):431-7. doi: 10.1099/jmm.0.034744-0. Epub 2011 Oct 20. PubMed PMID: 22016560; PubMed Central PMCID: PMC3347965.

Vien le TM, Minh NN, Thuong TC, Khuong HD, Nga TV, Thompson C, Campbell JI, de Jong M, Farrar JJ, Schultsz C, van Doorn HR, Baker S. The co-selection of fluoroquinolone resistance genes in the gut flora of Vietnamese children. PLoS One. 2012;7(8):e42919. doi: 10.1371/journal.pone.0042919. Epub 2012 Aug 24. PubMed PMID: 22937000; PubMed Central PMCID: PMC3427306.

Parry CM, Vinh H, Chinh NT, Wain J, Campbell JI, Hien TT, Farrar JJ, Baker S. The influence of reduced susceptibility to fluoroquinolones in Salmonella enterica serovar Typhi on the clinical response to ofloxacin therapy. PLoS Negl Trop Dis. 2011 Jun;5(6):e1163. doi: 10.1371/journal.pntd.0001163. Epub 2011 Jun 21. PubMed PMID: 21713025; PubMed Central PMCID: PMC3119645.

Vien le TM, Abuoun M, Morrison V, Thomson N, Campbell JI, Woodward MJ, Van Vinh Chau N, Farrar J, Schultsz C, Baker S. Differential phenotypic and genotypic characteristics of qnrS1-harboring plasmids carried by hospital and community commensal enterobacteria. Antimicrob Agents Chemother. 2011 Apr;55(4):1798-802. doi: 10.1128/AAC.01200-10. Epub 2011 Jan 31. PubMed PMID: 21282449; PubMed Central PMCID: PMC3067134.

Holt KE, Dolecek C, Chau TT, Duy PT, La TT, Hoang NV, Nga TV, Campbell JI, Manh BH, Vinh Chau NV, Hien TT, Farrar J, Dougan G, Baker S. Temporal fluctuation of multidrug resistant salmonella typhi haplotypes in the mekong river delta region of Vietnam. PLoS Negl Trop Dis. 2011 Jan 4;5(1):e929. doi: 10.1371/journal.pntd.0000929. PubMed PMID: 21245916; PubMed Central PMCID: PMC3014949.

Hoa NT, Chieu TT, Nghia HD, Mai NT, Anh PH, Wolbers M, Baker S, Campbell JI, Chau NV, Hien TT, Farrar J, Schultsz C. The antimicrobial resistance patterns and associated determinants in Streptococcus suis isolated from humans in southern Vietnam, 1997-2008. BMC Infect Dis. 2011 Jan 6;11:6. doi: 10.1186/1471-2334-11-6. PubMed PMID: 21208459; PubMed Central PMCID: PMC3022717.

Parry CM, Thuy CT, Dongol S, Karkey A, Vinh H, Chinh NT, Duy PT, Thieu Nga TV, Campbell JI, Van Minh Hoang N, Arjyal A, Bhutta ZA, Bhattacharya SK, Agtini MD, Dong B, Canh do G, Naheed A, Wain J, Tinh Hien T, Basnyat B, Ochiai L, Clemens J, Farrar JJ, Dolecek C, Baker S. Suitable disk antimicrobial susceptibility breakpoints defining Salmonella enterica serovar Typhi isolates with reduced susceptibility to fluoroquinolones. Antimicrob Agents Chemother. 2010 Dec;54(12):5201-8. doi: 10.1128/AAC.00963-10. Epub 2010 Sep 13. PubMed PMID: 20837759; PubMed Central PMCID: PMC2981260.

Nguyen NT, Ha V, Tran NV, Stabler R, Pham DT, Le TM, van Doorn HR, Cerdeo-Torraga A, Thomson N, Campbell J, Nguyen VM, Tran TT, Pham MV, Cao TT, Wren B, Farrar J, Baker S. The sudden dominance of blaCTX-M harbouring plasmids in Shigella spp. Circulating in Southern Vietnam. PLoS Negl Trop Dis. 2010 Jun 8;4(6):e702. doi: 10.1371/journal.pntd.0000702. PubMed PMID: 20544028; PubMed Central PMCID: PMC2882334.

Vinh H, Nhu NT, Nga TV, Duy PT, Campbell JI, Hoang NV, Boni MF, My PV, Parry C, Nga TT, Van Minh P, Thuy CT, Diep TS, Phuong le T, Chinh MT, Loan HT, Tham NT, Lanh MN, Mong BL, Anh VT, Bay PV, Chau NV, Farrar J, Baker S. A changing picture of shigellosis in southern Vietnam: shifting species dominance, antimicrobial susceptibility and clinical presentation. BMC Infect Dis. 2009 Dec 15;9:204. doi: 10.1186/1471-2334-9-204. PubMed PMID: 20003464; PubMed Central PMCID: PMC2803792.

Le TM, Baker S, Le TP, Le TP, Cao TT, Tran TT, Nguyen VM, Campbell JI, Lam MY, Nguyen TH, Nguyen VV, Farrar J, Schultsz C. High prevalence of plasmid-mediated quinolone resistance determinants in commensal members of the Enterobacteriaceae in Ho Chi Minh City, Vietnam. J Med Microbiol. 2009 Dec;58(Pt 12):1585-92. doi: 10.1099/jmm.0.010033-0. Epub 2009 Aug 20. PubMed PMID: 19696153; PubMed Central PMCID: PMC2884939.

Campbell JI, Lam TM, Huynh TL, To SD, Tran TT, Nguyen VM, Le TS, Nguyen vV, Parry C, Farrar JJ, Tran TH, Baker S. Microbiologic characterization and antimicrobial susceptibility of Clostridium tetani isolated from wounds of patients with clinically diagnosed tetanus. Am J Trop Med Hyg. 2009 May;80(5):827-31. PubMed PMID: 19407132.

Vinh H, Baker S, Campbell J, Hoang NV, Loan HT, Chinh MT, Anh VT, Diep TS, Phuong le T, Schultsz C, Farrar J. Rapid emergence of third generation cephalosporin resistant Shigella spp. in Southern Vietnam. J Med Microbiol. 2009 Feb;58(Pt 2):281-3. doi: 10.1099/jmm.0.002949-0. PubMed PMID: 19141753.

Carrique-Mas, J. J., Bryant, J. E., Cuong, N. V., Hoang, N. V., Campbell, J., Hoang, N. V., Dung, T. T., Duy, D. T. Hoa, N. T., Thompson, C., Hien, V. V., Phat, V. V., Farrar, J., Baker, S. (2013). An epidemiological investigation of Campylobacter in pig and poultry farms in the Mekong delta of Vietnam. Epidemiol Infect Sep 25: 1-12. PMID 26067502

J Carrique-Mas, Nguyen V. Trung, Ngo T. Hoa, H. Huynh Mai, Tuyen H. Thanh, James I. Campbell, Jaap A. Wagenaar, Anita Hardon, Thai Quoc Hieu, Constance Schultsz. Antimicrobial usage in chickens farming in Vietnam in the Mekong delta of Vietnam. Zoonoses & Publ Health (in press).