A Prospective Multi-Center Observational Study of Children Hospitalized with Diarrhea in Ho Chi Minh City, Vietnam

Abstract

We performed a prospective multicenter study to address the lack of data on the etiology, clinical and demographic features of hospitalized pediatric diarrhea in Ho Chi Minh City (HCMC), Vietnam. Over 2,000 (1,419 symptomatic and 609 non-diarrheal control) children were enrolled in three hospitals over a 1-year period in 2009–2010. Aiming to detect a panel of pathogens, we identified a known diarrheal pathogen in stool samples from 1,067/1,419 (75.2%) children with diarrhea and from 81/609 (13.3%) children without diarrhea. Rotavirus predominated in the symptomatic children (664/1,419; 46.8%), followed by norovirus (293/1,419; 20.6%). The bacterial pathogens Salmonella, Campylobacter, and Shigella were cumulatively isolated from 204/1,419 (14.4%) diarrheal children and exhibited extensive antimicrobial resistance, most notably to fluoroquinolones and third-generation cephalosporins. We suggest renewed efforts in generation and implementation of policies to control the sale and prescription of antimicrobials to curb bacterial resistance and advise consideration of a subsidized rotavirus vaccination policy to limit the morbidity due to diarrheal disease in Vietnam.

Case–control study of diarrheal disease etiology in individuals over 5 years in southwest China

“…Although bacteria and parasites were the prominent enteropathogen in acute diarrheal cases aged more than 5 years in some developing countries [31], to our surprise, viral pathogens (RVA and NoV) were the most common pathogen in present study.…”

“…Therefore, the prevalence of DEC was underestimated and the pathogenic spectrum of acute diarrheal illness was not accurately described [4]. It was accurately described to detect DEC by PCR with high sensitivity and specificity due to the following reasons [31]: Firstly, the clinical symptom of diarrhea caused by different DEC subtypes and other enteropathogens cannot be distinguished easily. Secondly, DEC is widely prevalent in food and environment, and the modern tourism and trade had accelerated the spread of DEC.…”

“…The modern detection method (e.g. PCR) can improve the sensitivity and specificity for detecting DEC in stool samples in order to accurately assess the burden of DEC in cases [4, 31]. In addition, the modern method has advantages in saving diagnosis time and reducing workload of finding DEC in diarrhea cases.…”

Challenges Encountered in Compliance to Hand Hygiene in the Pediatric Department of a Hospital in Central Vietnam

“…Jabbaret al showed that hand washing was significantly more effective at removing Clostridium difficile spores, while offering no statistical difference between hand rubbing with alcohol and hand rubbing with plain water [14].Shaking another person's hand following hand rubbing with alcohol also led to a transfer of 30% of residual spore to the recipient, showing easy transmission of Clostridium difficile from person to person. Furthermore, overuse of antibiotics in developing countries, such as Vietnam, has been a major and often neglected concern that contributed to antimicrobial resistance [15][16][17] and has rendered ABHR even less effective in preventing Clostridium difficile infection. Unfortunately, the association between Clostridium difficile with diarrhea and Clostridium difficile studies involving Asia remain sparse [18,19].Recalling the situation in QTGH, where ABHR remained the popular choice for hand hygiene and hand washing compliance was substantially low outside of NCIU, the risk of Clostridium difficile infection cannot be overlooked and should be evaluated.…”

Antibiotic Resistance of <i>Campylobacter jejuni</i> and <i>C. coli</i> Isolated from Children with Diarrhea in Thailand and Japan

“…Campylobacter jejuni and C. coli belong to the genus Campylobacter of the family Campylobacteraceae, and they are recognized among the most frequent causative factors of bacterial diarrhea worldwide, particularly in Southeast Asia (1)(2)(3)(4). Campylobacteriosis is usually self-limiting; however, antibiotic therapy is required in the most severe infections.…”