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      Emergence of carbapenem-resistant Acinetobacter baumannii as the major cause of ventilator-associated pneumonia in intensive care unit patients at an infectious disease hospital in southern Vietnam

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          Abstract

          Ventilator-associated pneumonia (VAP) is a serious healthcare-associated infection that affects up to 30 % of intubated and mechanically ventilated patients in intensive care units (ICUs) worldwide. The bacterial aetiology and corresponding antimicrobial susceptibility of VAP is highly variable, and can differ between countries, national provinces and even between different wards in the same hospital. We aimed to understand and document changes in the causative agents of VAP and their antimicrobial susceptibility profiles retrospectively over an 11 year period in a major infectious disease hospital in southern Vietnam. Our analysis outlined a significant shift from Pseudomonas aeruginosa to Acinetobacter spp. as the most prevalent bacteria isolated from quantitative tracheal aspirates in patients with VAP in this setting. Antimicrobial resistance was common across all bacterial species and we found a marked proportional annual increase in carbapenem-resistant Acinetobacter spp. over a 3 year period from 2008 (annual trend; odds ratio 1.656, P = 0.010). We further investigated the possible emergence of a carbapenem-resistant Acinetobacter baumannii clone by multiple-locus variable number tandem repeat analysis, finding a bla OXA-23-positive strain that was associated with an upsurge in the isolation of this pathogen. We additionally identified a single bla NDM-1-positive A. baumannii isolate. This work highlights the emergence of a carbapenem-resistant clone of A. baumannii and a worrying trend of antimicrobial resistance in the ICU of the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam.

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          Most cited references 29

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          Ventilator-associated pneumonia: diagnosis, treatment, and prevention.

          While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies.
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            How to detect NDM-1 producers.

            Enterobacterial isolates expressing the carbapenemase NDM-1 are emerging worldwide. Twenty-seven NDM-1-positive isolates of worldwide origin were included in this study to identify these strains as not only pathogens but also colonizers of normal flora for infection control screening. Although susceptibility to carbapenems varied, a combined test (IMP/IMP + EDTA), the Etest MBL, and automated susceptibility testing by Vitek2 (bioMérieux) identified those NDM-1 producers as verified by PCR using specific primers. Screening for carriers of NDM-1 producers may be based on media such as the ChromID ESBL culture medium routinely used to screen for extended-spectrum β-lactamase producers, which gives excellent detection levels with low limits of detection ranging from 8 × 10(0) to 5 × 10(2) CFU/ml. The CHROMagar KPC culture medium had higher limits of detection (1 × 10(1) to 5 × 10(5) CFU/ml) and may be proposed for the follow-up of outbreaks of infections with NDM-1 producers. Colonies growing on these screening media can be verified as NDM-1 producers with molecular methods as described herein.
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              A changing picture of shigellosis in southern Vietnam: shifting species dominance, antimicrobial susceptibility and clinical presentation

              Background Shigellosis remains considerable public health problem in some developing countries. The nature of Shigellae suggests that they are highly adaptable when placed under selective pressure in a human population. This is demonstrated by variation and fluctuations in serotypes and antimicrobial resistance profile of organisms circulating in differing setting in endemic locations. Antimicrobial resistance in the genus Shigella is a constant threat, with reports of organisms in Asia being resistant to multiple antimicrobials and new generation therapies. Methods Here we compare microbiological, clinical and epidemiological data from patients with shigellosis over three different periods in southern Vietnam spanning14 years. Results Our data demonstrates a shift in dominant infecting species (S. flexneri to S. sonnei) and resistance profile of the organisms circulating in southern Vietnam. We find that there was no significant variation in the syndromes associated with either S. sonnei or S. flexneri, yet the clinical features of the disease are more severe in later observations. Conclusions Our findings show a change in clinical presentation of shigellosis in this setting, as the disease may be now more pronounced, this is concurrent with a change in antimicrobial resistance profile. These data highlight the socio-economic development of southern Vietnam and should guide future vaccine development and deployment strategies. Trial Registration Current Controlled Trials ISRCTN55945881
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                Author and article information

                Journal
                J Med Microbiol
                J. Med. Microbiol
                JMM
                medmicro
                Journal of Medical Microbiology
                Society for General Microbiology
                0022-2615
                1473-5644
                October 2014
                October 2014
                : 63
                : Pt 10
                : 1386-1394
                Affiliations
                [1 ]The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
                [2 ]School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
                [3 ]The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
                [4 ]Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
                [5 ]Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
                [6 ]Division of Infectious Diseases, Department of Medicine, University of California San Francisco, CA, USA
                [7 ]Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
                [8 ]The London School of Hygiene and Tropical Medicine, London, UK
                Author notes
                Correspondence Stephen Baker sbaker@ 123456oucru.org
                Article
                076646
                10.1099/jmm.0.076646-0
                4170484
                25038137
                © 2014 The Authors

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Product
                Funding
                Funded by: Wellcome Trust
                Award ID: 089276/2/09/2
                Funded by: VIZIONS Hospital Disease Surveillance Consortium
                Award ID: WT/093724/Z/10/Z
                Funded by: Wellcome Trust/The Royal Society
                Award ID: 100087/Z/12/Z
                Categories
                Standard
                Clinical Microbiology and Virology
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                Microbiology & Virology

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