van Wijk Max, Tran Hoang Huy, Vu Bich Ngoc Thi, Tacoli Costanza, Nguyen Tu Cam Thi, Pham Quynh Dieu, Nguyen Thương Hong Thi, Nguyen Trang Thu, Nguyen Hien Anh Thi, Trinh Tung Son, Pham Thai Duy, Tran Huong Kieu Thi, Vu Dung Tien Viet, Dang Duc Anh, Tran Tien Dac, Nguyen Duong Thanh, van Doorn H Rogier, Kesteman Thomas, Lewycka Sonia
Oxford University Clinical Research Unit (OUCRU), National Hospital for Tropical Diseases, 78 Giai Phong, Dong Da District, Hanoi, Vietnam.
Faculty of Pharmacy - University of Tours, 31 Avenue Monge, 37200, Tours, France.
Lancet Reg Health West Pac. 2025 Jan 13;54:101281. doi: 10.1016/j.lanwpc.2024.101281. eCollection 2025 Jan.
Antimicrobial resistance (AMR) is a silent pandemic causing 1.27 million deaths in 2019, disproportionately affecting low- and middle-income countries, but resistance among commensal microbiota and the determinants of carriage have not been widely reported. This cross-sectional household study aimed to determine the prevalence of carbapenem-resistant (CRE) and third-generation cephalosporin-resistant Enterobacterale (C3GRE) in a rural community in Ha Nam northern Vietnam, as well as the socio-demographic, behavioural, and environmental determinants of carriage.
1502 individuals across 324 households were surveyed between July 2018 and April 2019. Faecal samples were cultured on meropenem and ceftazidime supplemented media to identify CRE and C3GRE, respectively. Logistic regression models were used to explore risk factors for CRE and C3GRE carriage compared to susceptible strains.
Colonisation with C3GRE and CRE was 94.0% (95% Confidence Interval (CI) 93.5%-94.4%) and 1.9% (1.6%-2.2%), respectively. The CRE prevalence was too low to explore determinants. Antibiotic use in the last month (adjusted OR 1.22 [95% CI 0.45-3.31]) and recent illness (aOR 1.48 [0.34-6.51]) were not associated with C3GRE carriage. Variables associated with C3GRE carriage were high-income (OR 0.29 [0.12-0.74]), worse sanitary conditions (aOR 4.35 [1.07-17.43]), and frequent beef consumption (aOR 6.56 [2.16-19.98]). A protective association between C3GRE carriage and animal husbandry was observed in children under 5-years (aOR 0.27 [0.09-0.84]). For participants 5-years and older, chicken consumption was associated with increased likelihood of C3GRE carriage (aOR 3.45 [1.45-8.22]), while a protective association was observed for regular tofu (aOR 0.32 [0.14-0.74]) and fermented food consumption (aOR 0.55 [0.31-0.96]).
In this high-prevalence setting, colonisation with C3GRE was not associated with individual antibiotic use, while environmental exposures, including food and sanitary conditions, were associated with C3GRE colonisation. Further research is required to understand the mechanisms behind these associations.
This work was supported by Oxford University Clinical Research Unit internal grants in Vietnam from the Wellcome Trust Africa Asia Programme core grants (2015-2022-106680/Z/14/Z, and 2022-2029-225167/Z/22/Z).
抗菌药物耐药性（AMR）是一场无声的大流行，在2019年导致127万人死亡，对低收入和中等收入国家的影响尤为严重，但共生微生物群中的耐药性及其携带的决定因素尚未得到广泛报道。这项横断面家庭研究旨在确定越南北部河南省一个农村社区中耐碳青霉烯类（CRE）和耐第三代头孢菌素肠杆菌（C3GRE）的流行情况，以及携带这些病菌的社会人口学、行为和环境决定因素。
在2018年7月至2019年4月期间，对324户家庭中的1502人进行了调查。粪便样本分别在添加美罗培南和头孢他啶的培养基上培养，以鉴定CRE和C3GRE。与敏感菌株相比，采用逻辑回归模型探讨CRE和C3GRE携带的危险因素。
C3GRE和CRE的定植率分别为94.0%（95%置信区间（CI）93.5%-94.4%）和1.9%（1.6%-2.2%）。CRE的患病率过低，无法探究其决定因素。过去一个月内使用抗生素（调整后的比值比为1.22[95%CI 0.45-3.31]）和近期患病（调整后的比值比为1.48[0.34-6.51]）与C3GRE携带无关。与C3GRE携带相关的变量包括高收入（比值比为0.29[0.12-0.74]）、卫生条件较差（调整后的比值比为4.35[1.07-17.43]）和频繁食用牛肉（调整后的比值比为6.56[2.16-19.98]）。在5岁以下儿童中，观察到C3GRE携带与畜牧业之间存在保护关联（调整后的比值比为0.27[0.09-0.84]）。对于5岁及以上的参与者，食用鸡肉与C3GRE携带可能性增加相关（调整后的比值比为3.45[1.45-8.22]），而经常食用豆腐（调整后的比值比为0.32[0.14-0.74]）和发酵食品（调整后的比值比为0.55[0.31-0.96]）则观察到保护关联。
在这种高流行率的情况下，C3GRE定植与个体使用抗生素无关，而包括食物和卫生条件在内的环境暴露与C3GRE定植相关。需要进一步研究以了解这些关联背后的机制。
这项工作得到了牛津大学临床研究单位在越南的内部资助，该资助来自惠康信托基金亚非计划核心资助（2015-2022-106680/Z/14/Z和2022-2029-225167/Z/22/Z）。
