Antimicrobial use and resistance data in human and animal sectors in the Lao PDR: evidence to inform policy.

OBJECTIVES: To review the scientific evidence base on antimicrobial use (AMU) and antimicrobial resistance (AMR) in human and animal sectors in the Lao PDR (Laos). METHODS: We reviewed all publications from July 1994 (the first article describing AMR in Laos) to December 2020. Electronic searches were conducted using Google Scholar and PubMed with specific terms relating to AMR and AMU in Lao, French and English languages. FINDINGS: We screened 1,357 peer-reviewed and grey reports by title and abstract and then full articles/reports. Of 80 included, 66 (83%) related to human health, nine (11%) to animal health, four (5%) to both animal and human health and one (1%) to the environment. Sixty-two (78%) were on AMR and 18 (22%) on AMU. Extended spectrum beta lactamase-producing Escherichia coli was the greatest concern identified; the proportion of isolates increased fivefold from 2004 to 2016 (2/28 (7%) to 27/78 (35%)) from blood cultures submitted to the Microbiology Laboratory, Mahosot Hospital, Vientiane. Carbapenem resistant Escherichia coli was first identified in 2015. Methicillin-resistant Staphylococcus aureus (MRSA) was uncommon, with 15 cases of MRSA from blood cultures between its first identification in 2017 and December 2020. AMR patterns of global antimicrobial resistance surveillance system (GLASS) target pathogens from livestock were less well documented. There were few data on AMU in human health and none on AMU in livestock. The first hospital AMU survey in Laos showed that 70% (1,386/1,981) of in-patients in five hospitals from 2017 to 2018 received antimicrobial(s). Antibiotic self-medication was common. CONCLUSION: AMR in Laos is occurring at relatively low proportions for some GLASS pathogens, giving the country a window of opportunity to act quickly to implement strategies to protect the population from a worsening situation. Urgent interventions to roll out new guidelines with enhanced one-health antibiotic stewardship, reduce antibiotic use without prescriptions, enhance surveillance and improve understanding of AMU and AMR are needed.

Significant mortality of large ruminants due to hypothermia in northern and central Lao PDR.

An extreme cold exposure event occurred between March 14th and 19th 2011 in northern and central Lao PDR resulting in a major mortality of cattle and buffalo. At least six northern and one central province reported losses, involving 46 districts and 1,384 smallholder farmers, with a total of 7,162 cattle and 3,744 buffalo reported to have died in association with cold weather. Affected animals were observed to shiver, display slow and shallow respiration, lose consciousness and eventually die. Many deaths occurred at night and were recorded in both sexes and all ages of large ruminants. However, mortalities occurred mostly in animals that were free-grazing in the forest and natural grassland, and exposed to the cold weather. Some housed animals that were provided with warmth from shelter and fires and supplementary feed did not die. Samples from dead animals collected for laboratory analysis confirmed that bacterial or viral pathogens were not present. The cause of the mortality was attributed to hypothermia, and the economic losses were estimated at USD 2,463,912.00. Xieng Khouang Province reported the most severe losses with deaths of 4,600 cattle and 1,665 buffalo. At Thong Haihin meteorological station in this province on March 16th and 17th 2011, minimum temperatures recorded were 6.7°C and 7.5°C and rainfall recorded was 36.6 mm and 61.7 mm, respectively. This was the first reported extreme cold event in living memory occurring between the end of dry season and beginning of the wet season in northern Laos. This event is reported in detail as it caused a major loss of wealth for poor smallholder farmers and indicates that strategies to minimise the impact of extreme cold weather events need to be included in livestock development extension programmes.