Hospital surveillance predicts community pneumococcal antibiotic resistance in Vietnam.

BACKGROUND: In Vietnam, Streptococcus pneumoniae is a leading cause of disease, including meningitis. Antibiotics are available without physician prescription at community pharmacies and rates of antibiotic non-susceptibility are high. Appropriate treatment and antibiotic stewardship need to be informed by surveillance data. OBJECTIVES: To report community-based pneumococcal antibiotic susceptibility testing data from children enrolled in a pneumococcal conjugate vaccine trial in Ho Chi Minh City [the Vietnam Pneumococcal Project (ViPP)] and compare these with published hospital-based data from the nationwide Survey of Antibiotic Resistance (SOAR) to determine whether hospital surveillance data provide an informative estimate of circulating pneumococcal resistance. METHODS: Pneumococcal isolates from 234 nasopharyngeal swabs collected from ViPP participants at 12 months of age underwent antibiotic susceptibility testing using CLSI methods and the data were compared with SOAR data. RESULTS: Antibiotic susceptibility testing identified penicillin-non-susceptible pneumococci in 93.6% of pneumococcus-positive ViPP swabs (oral, non-meningitis breakpoints). Non-susceptibility to erythromycin, trimethoprim/sulfamethoxazole, clindamycin and tetracycline also exceeded 79%. MDR, defined as non-susceptibility to three or more classes of antibiotic, was common (94.4% of swabs). Low or no resistance was detected for ceftriaxone (non-meningitis breakpoints), ofloxacin and vancomycin. Antibiotic non-susceptibility rates in ViPP and SOAR were similar for several antibiotics tested. CONCLUSIONS: A very high proportion of pneumococci carried in the community are MDR. Despite wide disparities in population demographics between ViPP and SOAR, the non-susceptibility rates for several antibiotics were comparable. Thus, with some qualification, hospital antibiotic susceptibility testing data in Vietnam can inform circulating pneumococcal antibiotic non-susceptibility in young children, the group at highest risk of pneumococcal disease, to guide antibiotic prescribing and support surveillance strategies.

[Early neonatal mortality at the gynecological-obstetrical hospital of Hanoi, Vietnam]. / Mortalité néonatale précoce à l'hôpital de gynécologie-obstétrique de Hanoï, Vietnam.

A retrospective study was conducted of a series of 18,834 births at the gynaecological-obstetrics hospital of Hanoi, Vietnam, from January 1-1991 to December 31-1995. The mean early neonatal mortality rate was 24.4". During the study period, a considerable decrease in rate was observed, which was attributed to a change in patient profile. The registered causes of death were primarily due to premature delivery and/or respiratory distress (70%). Forty-nine percent of the early neonatal deaths occurred during the first day of life. The risk factors for early neonatal death were assessed. Improved surveillance at the hospital of delivery practices is necessary and the problem of prematurity should be approached from a broad perspective.