Prevalence of carbapenem resistance and its potential association with antimicrobial use in humans and animals in rural communities in Vietnam

Abstract

Background Vietnam and Southeast Asia are hotspots for antimicrobial resistance; however, little is known on the prevalence of carriage of carbapenem resistance in non-hospitalized humans and in animals. Carbapenem-resistant Enterobacteriaceae (CRE), particularly Escherichia coli (CREC) and Klebsiella pneumoniae (CRKP) and also Acinetobacter baumannii (CRAB) are emerging threats worldwide. Methods We investigated healthy humans (n = 652), chickens (n = 237), ducks (n = 150) and pigs (n = 143) in 400 small-scale farms in the Mekong Delta of Vietnam. Samples (rectal swabs, faecal swabs) were investigated for carriage of CRE/CRAB and were further characterized phenotypically and genotypically. Results In the Mekong Delta of Vietnam, the prevalence of CRE isolates in human rectal swabs was 0.6%, including 4 CREC and 1 CRKP. One pig was infected with CREC (prevalence 0.7%). CRAB was isolated from chickens (n = 4) (prevalence 2.1%) and one duck (prevalence 0.7%). CRKP was isolated from a human who was also colonized with CREC. The CRKP strain (ST16), from an 80 year-old person with pneumonia under antimicrobial treatment, genetically clustered with clinical strains isolated in a hospital outbreak in southern Vietnam. The prevalence of CRE was higher among humans that had used antimicrobials within 90 days of the sampling date than those had not (4.2% versus 0.2%) (P = 0.005). All CRE/CRAB strains were MDR, although they were susceptible to colistin and neomycin. The carbapenemase genes identified in study strains were blaNDM and blaOXA. Conclusions The finding of a CRKP strain clustering with previous hospital outbreak raises concerns about potential transmission of carbapenem-resistant organisms from hospital to community settings or vice-versa.

Evaluation of screening algorithms to detect rectal colonization with carbapenemase-producing Enterobacterales in a resource-limited setting

“…Supporting our findings, a recent study by Yen et al 19 investigating the prevalence of CRE in rural Vietnam identified both bla NDM and bla OXA as the predominant carbapenemase genes. It is worth noting that many studies are conducted in hospital settings, often involving critically ill patients, particularly those in ICUs, or are focused on specific bacterial species.…”

A systematic review and meta-analysis of integrated studies on antimicrobial resistance in Vietnam, with a focus on Enterobacteriaceae, from a One Health perspective

“…In addition to NTS and E. coli (both commensal and pathogenic), other Enterobacteriaceae including Klebsiella spp., and Shigella spp., have been monitored for their AMR profiles in human populations [ 6 ]. Resistance to the last-resort antimicrobial drugs (such as carbapenem and colistin) among Enterobacteriaceae has increased globally, especially in LMICs [ [7] , [8] , [9] ]. Increased resistance among Enterobacteriaceae is partly associated with the overuse of antimicrobials in animal production systems [ [10] , [11] , [12] , [13] ].…”

Fecal carriage and genetic characteristics of carbapenem-resistant enterobacterales among adults from four provinces of China

“…These rates are higher than the rates of 6.6% and 8.5% in 2014 and 2019 studies from China, respectively ( 29 , 30 ), but lower than the rates of 12.2% in Japan ( 31 ) and 37.9% in Iran ( 32 ). Previous studies among non-hospitalized human rectal swabs reported carriage rates of CRE of 0.6% in Vietnam ( 33 ), 0.4% in Spain ( 34 ), and 6.1% in India ( 35 ). However, the prevalence of CRE (10.84%) among hospitalized patients was a much lower than the 13% reported from Vietnam ( 36 ), and higher than the 2.9% rate in Spain ( 34 ).…”