Molecular Epidemiology of Escherichia coli Resistant to Carbapenems, Fluoroquinolones, and Aminoglycosides Isolated from One of the Largest Hospitals in Vietnam in 2014-2019.

Introduction: Multidrug-resistant (MDR) Gram-negative bacilli including carbapenem-resistant Gram-negative Enterobacteriaceae (CRE) threaten global health. Little is known, however, about the distribution of antimicrobial resistance genes in MDR isolated from patients in Vietnamese hospitals. In this study, we collected MDR Escherichia coli, defined as E. coli resistance against all fluoroquinolones, aminoglycosides, and carbapenems. Aim: This study was designed to clarify the molecular epidemiology of Escherichia coli isolates resistant to carbapenems, fluoroquinolones, and aminoglycosides isolated from patients admitted to one of the largest hospitals in Vietnam in 2014-2019 based on both whole-genome sequencing (WGS) and phenotypic data. Methodology. Sixty-seven Vietnamese isolates screened by drug resistance by the disk test were subjected to WGS, and their sequences were analyzed to determine their multilocus sequence type (MLST), O-types, H-types, distribution of drug resistance genes, plasmid types, pathogenicity islands (PIs), virulence factor distribution, and phylogenetic evolution using the WGS data. Results: Among the STs detected, ST410 was relatively dominant. Dominant O-types and H-types were O102 and H9 and showed some links, such as those between O102 and H8. The most dominant plasmid type and carbapenemase type were 4 and NDM-5, respectively. MLST, O-types, H-types, plasmid types, and types of carbapenemases were very heterogeneous among the isolates, with no clear correlation between them. Dominant plasmid type carrying drug resistance gene was IncQ1_1. The percentage of isolates positive for drug resistance genes, such as anti-beta-lactams and aminoglycosides, was relatively high because the isolates screened were resistant to carbapenems, fluoroquinolones, and aminoglycosides. Conclusions: MDR E. coli isolates isolated at a high-volume Vietnamese hospital were very heterogeneous, suggesting that they were acquired from different sources, including nosocomial infection, animals, and water. Eradication of MDR E. coli from hospitals and other clinical environments is very challenging because a single measure may be ineffective.

Evaluation of the Etest method for detecting colistin susceptibility of multidrug-resistant Gram-negative isolates in Vietnam.

The minimum inhibitory concentrations (MICs) of colistin for 241 multidrug-resistant (MDR) Gram-negative pathogens were determined by the Etest and by the broth microdilution method (BMD). The two methods showed essential agreements of 76% (77/102) for Acinetobacter baumannii, 90% (36/40) for Pseudomonas aeruginosa and 84% (83/99) for Enterobacteriaceae isolates, with categorical agreements of 100%, 98%, and 100%, respectively. Of the 241 isolates, none showed a very major error and one (0.4%) showed a major error. MICs ranged from 0.125 to 0.5 µg/ml for all A. baumannii and most Enterobacteriaceae isolates, and from 1 to 2 µg/ml for most P. aeruginosa isolates. Of the 40 P. aeruginosa isolates, 27 (68%) showed higher colistin MICs by the Etest than by the BMD. In contrast, 77% (78/102) of the A. baumannii and 57% (56/99) of the Enterobacteriaceae isolates showed lower colistin MICs by the Etest than by the BMD. The Etest is a reliable and easy-to-use method to measure colistin MICs of MDR Gram-negative pathogens in clinical laboratories and can be used following validation by microdilution methods.

Assessment of Bacteremia in a Large Tertiary Care Hospital in Northern Vietnam: a Single-Center Retrospective Surveillance Study.

The clinical analysis of cases of bacteremia is valuable. However, limited data on bacteremia are available in Vietnam. We conducted a single-center retrospective surveillance study at the Bach Mai Hospital, Hanoi, Vietnam between 2009 and 2012. In total, 45,366 blood cultures were analyzed. The number of blood cultures per 1,000 patient-days was 9.59 sets. The percentage of solitary blood culture sets was 49.6%, and the rate of positive blood cultures was 13.9%. The major pathogens isolated in adults were coagulase-negative Staphylococcus species (16.7%), followed by Escherichia coli (6.8%), Streptococcus spp. excluding Streptococcus pneumoniae (3.8%), and Staphylococcus aureus (5.2%). Other major pathogens identified were Klebsiella spp. (4.2%) and Acinetobacter spp. (2.2%). The number of blood cultures per 1,000 patient-days was lower and the percentage of solitary blood culture sets higher than that of a Japanese study (9.6 vs. 25.2 and 49.6% vs. 32.8%, respectively). The distribution of microorganisms was unique in terms of the relative predominance of cases of Acinetobacter bacteremia. The percentage of cases of healthcare-associated bacteremia may be relatively high.

Descriptive epidemiology of clubfoot in Vietnam: a clinic-based study.

The prevalence of congenital talipes equinovarus (clubfoot) in Vietnam is estimated to be approximately one in 1000 births. To date, no epidemiological studies have been conducted in this country to assess risk factors associated with this deformity. The purpose of this study was to evaluate specific environmental and socioeconomic factors that may increase the risk of an infant being born with clubfoot. A descriptive clinic-based study was conducted using structured questionnaires given to biological mothers of clinically confirmed clubfoot subjects (n=99) and biological mothers of children between ages 0-18 with no first or second degree family history of clubfoot as controls (n=97). Phenotypic data from clubfoot subjects was also collected. We found that males were twice as likely to have clubfoot and half of clubfoot subjects were affected bilaterally. There was no significant difference in the rate of left versus right clubfoot. Infant and maternal characteristics showing a strong association with clubfoot included breech presentation at birth (p=0.026) and young maternal age (p=0.033). Although there were no strong correlations with any sociodemographic paternal characteristics, a higher percentage of case fathers were younger at the age of conception compared to control fathers. The information from this preliminary study provides a framework for future epidemiologic studies in this population. An understanding of the risk factors associated with clubfoot will play an important role in understanding the pathophysiology of this disabling deformity.

Evaluation of the progress and challenges facing the Ponseti method program in Vietnam.

INTRODUCTION: In 2003, an ICRC-SFD Ponseti program was introduced in southern Vietnam. Additional programs were introduced by the Prosthetics Outreach Foundation and independently by physicians trained at our center. The purpose of this study was to evaluate the impact, progress and challenges facing Ponseti practitioners and patients' family members in Vietnam. In addition, web-conferencing (Ponseti Virtual Forum) for continued medical education in the method was also assessed. METHODS: Multiple questionnaires were developed to conduct face-to-face practitioner interviews, focus group interviews, and parental interviews. Observation was done at multiple site clinics to determine or confirm additional challenges faced by practitioners. Web conferencing was introduced to sites in Ho Chi Minh City and Da Nang City. RESULTS: The number of clubfoot patients treated with the Ponseti method has increased over time with approximately 1,252 infants treated between 2003 and 2010. Specific challenges were identified relating to communication, networking, distance and transportation, and finances for both practitioners and parents. The PVF was not only found to facilitate rapid, relevant dissemination of medical knowledge--thus increasing physician and patient satisfaction--but it may also be found to act as an interface in which medical culture, insight, and compassion are shared benefiting all virtual forum participants. CONCLUSION: The identified progress and challenges mirrored that of similar studies done in other countries with several factors affecting progress. Focusing on improving communication channels and networking while working with the ministry of health may improve the facilitation of the Ponseti method in Vietnam. Further implementation and evaluation of the PVF may act as a guide for current and future programs in Vietnam or other countries.