Monitoring ARGs in Vietnam:
current development and future directions

This June marks the final session on our webinar series covering antibiotic resistance surveillance in low and middle- income countries. In this final webinar, we had guest speakers Dr. Hoang Huy Tran from the National Institute of Hygiene and Epidemiology (NIHE), Vietnam, and Dr. Ikuro Kasuga from University of Tokyo , Japan. During this webinar, we had the chance to understand the current situation of antimicrobial resistance surveillance in Vietnam, as speakers explain their projects monitoring clinical and environmental issues in Vietnam’s battle against antibiotic resistances.

Dr. Hoang began the webinar with a brief presentation regarding past clinical projects in Vietnam, then bridging such research with future plans in monitoring antimicrobial resistance in Vietnamese chicken farms to further trace the spread of certain resistant bacteria in the environment. Dr. Hoang’s past clinical research project with NIHE found that plasmid carrying KPC genes had spread quickly between three major hospitals in Vietnam through patient transfer, along with the discovery of IMP gene variants. Additionally, Dr. Hoang’s research also found that most bacteria were widely resistant to colistin, which is the recommended medication to be used as a salvage treatment for infections caused by carbapenem-resistant bacteria. With findings suggesting such degrees of antibiotic resistance in Vietnam, there may be no effective antibiotic resistant treatments for these bacteria in the near future.
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The bacteria found in Dr. Hoang’s clinical surveillance project, which includes the multi-drug resistant Pseudomonas aeruginosa, is also highly adaptable to environmental fluctuations with multiple resistance mechanisms. This does not only help identify the risk of outbreaks in hospitals, but also further transmission to the environment. Dr. Hoang thus ends his presentation with hopeful plans for future environmental surveillance projects in Vietnam. Dr. Hoang’s future research hopes to map plans in isolated chicken farms, and to further incorporate insect samples, to fully illustrate the environmental transmission of resistant bacteria.
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As our next speaker, Dr. Kasuga spoke about the development of wastewater treatment in Hanoi with regard to environmental resistance monitoring. The vast majority 88% of pharmacies in the urban areas in Vietnam sells antibiotics without prescription. The health threat in clinical antibiotic use is critical as Vietnam has an alarmingly high proportion of pathogens resistant to some antibiotics such as cefotaxime, amikacin, and imipenem. ARG pollution in Vietnamese water environment is tightly associated with the discharge of untreated wastewater. Only 10% of domestic wastewater is currently treated. Meanwhile, the rest is released without any treatment or is only treated by septic tanks of which its performance is not sufficient due to low maintenance , and lack of disinfection processes. Pollution from septic tank effluent and untreated domestic wastewater creates very dark wastewater because of the anoxic conditions, and sometimes this water is used for agriculture and irrigation, which in turn allows for resistant genes such as mcr-1 to transmit from water to vegetables, and eventually to healthy residents.

Dr. Kasuga introduced a research project in line with the WHO Tricycle Project, which utilized the One Health approach to examine the frequency of ESBL-producing E. coli in humans, animals, and environment. ESBL-producing E. coli was selected as a single indicator in the project. The project utilized two approaches: WHO’s Tricycle protocol and High-Throughput qPCR surveillance. Results showed ESBL-producing E. coli which is resistant to cefotaxime in the water environment and food chain in Vietnam. For water sampling, regular sampling was done over urban drainage, wastewater and urban rivers in Hanoi and Bac Ninh. Isolates from the two cities showed very similar antibiotic susceptibility profiles.

Although Vietnam is a hotspot of bacteria resistant to some of the strongest antibiotics in the world, both speakers this month showed that developments for hopeful improvement is underway. Recent developments of wastewater treatment plants in Hanoi themselves have already grown from 2005, with will increase coverage of wastewater treatment to 40% by 2022. Present efforts and successes in the holistic approach in both clinical and environmental research is further testament to the potential that the One Health message holds for the worldwide battle against antibiotic resistance.