Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, 78 Giai Phong, Dong Da, Hanoi, Viet Nam.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Antimicrob Resist Infect Control. 2021 May 10;10(1):78. doi: 10.1186/s13756-021-00937-4.
To analyse data from 2016-17 from a hospital-based antimicrobial resistance surveillance with national coverage in a network of hospitals Viet Nam.
We 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.
42,553 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.
The 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.
分析 2016-17 年越南医院抗菌药物耐药监测网络中具有全国覆盖范围的基于医院的抗菌药物耐药数据。
我们分析了来自 13 家医院的数据，比 2012-13 年期间的数据集少了 3 家。使用来自常规诊断送检样本的临床微生物学实验室的鉴定和抗菌药物敏感性测试数据。使用临床和实验室标准协会 2018 年指南进行抗菌药物敏感性测试解释。使用 WHONET 进行数据输入、管理和分析。
本分析包括 42553 份已去重的分离株；包括 30222 株（71%）革兰氏阴性菌和 12331 株（29%）革兰氏阳性菌。8793 株（21%）来自 ICU，7439 株（18%）分离株来自侵袭性感染。大肠埃希菌和金黄色葡萄球菌是最常检测到的物种，分别有 9092 株（21%）和 4833 株（11%）；其次是肺炎克雷伯菌（3858 株 - 9.1%）和鲍曼不动杆菌（3870 株 - 9%）。细菌主要从痰液（8798 株 - 21%）、血液（7118 株 - 17%）和尿液（5202 株 - 12%）中分离。在革兰氏阳性菌中，3302/4515 株（73%）金黄色葡萄球菌为耐甲氧西林金黄色葡萄球菌；290 株（34%）粪肠球菌对万古霉素耐药；1136 株肺炎链球菌中 58%（663 株）对青霉素的敏感性降低。在革兰氏阴性菌中，59%（4085/6953）和 40%（1186/2958）的大肠埃希菌和肺炎克雷伯菌产生超广谱β-内酰胺酶，29%（376/1298）和 11%（961/8830）对碳青霉烯类耐药，分别。79%（2855/3622）和 45%（1514/3376）的鲍曼不动杆菌和铜绿假单胞菌对碳青霉烯类耐药，分别。88%（804/911）的流感嗜血杆菌对氨苄西林耐药，18/253（7%）的沙门氏菌和 7/46（15%）的志贺氏菌对氟喹诺酮类耐药。2016-2017 年提交数据的分离株数量是 2012-2013 年的两倍。对于大多数有意义的病原体-抗菌药物组合，包括耐亚胺培南的鲍曼不动杆菌、铜绿假单胞菌和肠杆菌科，2016-2017 年的 AMR 比例较高。
数据显示越南重要病原体的耐药比例令人震惊地高且呈上升趋势。各医院类型的 AMR 比例存在差异，由于存在采样偏差和分离株是否为社区获得性或医院获得性的信息缺失，因此应谨慎解释。应探索在网络中采用基于样本或病例的方法的经济实惠且可扩展的方法，并整合临床数据，以帮助更准确地推断监测数据。
