Ventilator associated pneumonia (VAP) is the commonest hospital acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant Gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia.We systematically reviewed literature published on Ovid MEDLINE, Embase Classic and Embase from 1st January 1990 to 17th Aug 2017 to estimate incidence, prevalence, and etiology of VAP. We performed meta-analysis of pooled data to give overall rates and rates by country income level.Pooled incidence density of VAP was high in low- and middle-income countries and lower in high-income countries (18.5, 15.2 and 9.0/1000 ventilator days respectively).Acinetobacter baumannii and Pseudomonas aeruginosa (26%, N=3687; 22%, N=3176) were leading causes of VAP, Staphylococcus aureus caused 14% (N=1999). Carbapenem resistance was common (57.1%).VAP remains a common cause of HAI, especially in low and middle income countries and antibiotic resistance is common.
Objectives
To review community-level consumption of antibiotics in rural Vietnam, according to the WHO Access, Watch, Reserve (AWaRe) classification of 2019, and identify factors associated with the choice of these antibiotics.
Methods
In this cross-sectional study, data on antibiotic purchases were collected through a customer exit survey of 20 community antibiotic suppliers in Ba Vi District, Hanoi, between September 2017 and July 2018. Antibiotic consumption was estimated through the number of antibiotic encounters, the number of DDDs supplied and the number of treatment days (DOTs) with antibiotics, and analysed according to the AWaRe classification. The factors associated with watch-group antibiotic supply were identified through multivariable logistic regression analysis.
Results
In total, there were 1342 antibiotic encounters, with access-group antibiotics supplied in 792 encounters (59.0%), watch-group antibiotics supplied in 527 encounters (39.3%) and not-recommended antibiotics supplied in 23 encounters (1.7%). No reserve-group antibiotics were supplied. In children, the consumption of watch-group antibiotics dominated in all three measures (54.8% of encounters, 53.0% of DOTs and 53.6% of DDDs). Factors associated with a higher likelihood of watch-group antibiotic supply were: private pharmacy (OR, 4.23; 95% CI, 2.8–6.38; P < 0.001), non-prescription antibiotic sale (OR, 2.62; 95% CI, 1.78–3.87; P < 0.001) and children (OR, 2.56; 95% CI, 1.84–3.55; P < 0.001).
Conclusions
High consumption of watch-group antibiotics was observed, especially for use in children. The frequent supply of watch-group antibiotics at private pharmacies reconfirms the need for implementing pharmacy-targeted interventions in Vietnam.
SUMMARYPorcine reproductive and respiratory syndrome (PRRS) outbreaks in pigs are associated
with increased susceptibility of pigs to secondary bacterial infections, including
Streptococcus suis – an important zoonotic pathogen causing bacterial
meningitis in humans. This case-control study examined the association between human
S. suis infection and PRRS outbreaks in pigs in northern Vietnam. We
included 90 S. suis case-patients and 183 non-S. suis
sepsis controls from a referral hospital in Hanoi in 2010, a period of major PRRS
epizootics in Vietnam. PRRS exposure was determined using data from the National Centre of
Veterinary Diagnosis. By univariate analysis, significantly more S. suis
patients were reported residing in or adjacent to a PRRS district compared to controls
[odds ratio (OR) 2·82, 95% confidence interval (CI) 1·35–5·89 and OR 3·15, 95% CI
1·62–6·15, respectively]. Only residency in adjacent districts remained significantly
associated with risk of S. suis infection after adjusting for sex,
occupation, and eating practices. SaTScan analysis showed a possible cluster of S.
suis infection in humans around PRRS confirmed locations during the
March–August period. The findings indicate an epidemiological association between PRRS in
pigs and S. suis infections in humans. Effective strategies to strengthen
control of PRRS in pigs may help reduce transmission of S. suis infection
to humans.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.