The Antimicrobial The Antimicrobial Resistance Resistance

Surveillance Surveillance Programme of Programme of Vietnam: Acute Vietnam: Acute respiratory tract respiratory tract

infectionsinfections

Do khang Chien, MD, PhD

Nguyen thi phuong cham, BSPh

nguyen thi thanh huong, MPh

10 most common diseases in 10 most common diseases in

20022002

0

50,000

100,000

150,000

200,000

250,000

Pneumonia

Acute pharyngitis and acute tonsilitis

Acute bronchitis and acutebronchiolitisDiarrhoea and gastroenteritis ofpresumed infectious originTransport accident

Essential hypertension

Influenzae

Diseases of appendix

Gastritis and duodenditis

Fracture of lower limb bones

Cases

Ref: Health statistics year book 2002

ObjectivesObjectives

• To determine the antimicrobial resistance situation of common pathogens for acute respritory tract infections

• To determine the susceptability of pathogens to antibiotics available in Vietnam

MethodsMethods

• Standard microbiology laboratory methods

• NCCLS (National Center for Control of Laboratory Standards)

• WHONET

0

20

40

60

80

100

%

S R

Eryt

hrom

ycin

Co-t

rimox

azol

e

Penic

illin

G

Cefta

zidim

e

Chlor

amph

enic

ol

Ceph

alot

hin

Ceftr

iaxo

ne

Cefo

taxim

e

Ampic

illin

Rate of resistance of Streptococcus pneumoniae

E r ythr omyc i n

C o- tr i moxaz ol e

P eni c i l l i n G

C ef taz i di me

C hl or ampheni c ol

C ephal othi n

C ef tr i axone

C ef otax i me

A mpi c i l l i n

0

10

20

30

40

50

60

70

80

90

100

Tû lÖ %

S R

Co

-tri

mo

xa

zole

Am

pic

illin

Ge

nta

mic

in

Au

gm

en

tin

Ce

fta

zid

ime

Ce

furo

xim

e

Ch

lora

mp

he

nic

ol

Ce

ftri

ax

on

e

Cip

rofl

ox

ac

in

Ery

thro

my

cin

Ce

fota

xim

e

Rate of resistance of Haemophilus influenzae

Co-trimoxazole

Ampicillin

Gentamicin

Augmentin

Ceftazidime

Cefuroxime

Chloramphenicol

Ceftriaxone

Ciprofloxacin

Erythromycin

Cefotaxime

0

50

100

%

S R

C o -trimo xa zo le

C e fu ro xime

C e fo ta xime

C e fta zid ime

C h lo ra mp h e n ic o l

Rate of resistance of Moraxella catarrhalis

C o-

tr i moxaz ol e

E r ythr omyc i n

C ef ur ox i me

A mpi c i l l i n

C ef otax i me

C i pr ofl oxac i n

C ef taz i di me

G entami c i n

C hl or ampheni

c ol

Percentage of sensitivity to antibioticsNo. Antibiotics H.I.

(%)

S. Pneu

(%)

Moraxella

(%)

1 Ampicilin 100

2 Ceftriaxone 79.3 97.7

3 Cephalothin 90.9

4 Benzyl-Penicillin 58.8

5 Chloramphenicol 45.5 80.7 90.9

6 Gentamicine 89.7

7 Cefotaxime 100

8 Ciprofloxacin 93.5 88.1

The patient record analysis of The patient record analysis of respiratory diseases and treatment respiratory diseases and treatment

regimens in 4 general hospitalsregimens in 4 general hospitals Locations Locations

Number of casesNumber of cases

1.1. Cao Bang General Hospital Cao Bang General Hospital 60 60 casescases

2.2. Lang Son General Hospital Lang Son General Hospital 60 60 casescases

3.3. Hoa An District Hospital Hoa An District Hospital 60 cases 60 cases

4.4. Huu Lung District Hospital Huu Lung District Hospital 60 cases60 cases

Total: Total: 240 cases 240 cases

MethodsMethods: retrospective case review based on patient : retrospective case review based on patient records records

Rate: Rate: 74 cases out of 240 are respiratory infections 74 cases out of 240 are respiratory infections accounted foraccounted for

38% 38%

Treatment regimens usedHospitals Cao

BangLang Son

Hoa An

Huu Lung

Total %

Drugs cases cases cases cases cases

Ampicillin (Injection)

1 2 8 5 16 21.6

Ampicillin +

Gentamicin

8 7 4 3 22 29.7

Penicillin G 0 0 3 3 4

Penicillin G + Gentamicin

2 3 3 8 10.8

Others 5 10 6 4 25 33.8

Common respiratory diseases

Hospitals Cao Bang

Lang Son

Hoa An

Huu Lung

Total %

Diseases cases cases cases cases cases

Pneumonia 7 3 1 6 17 23

Bronchitis 17 9 5 34 47

Pharyngitis 4 1 6 1 12 16

Tonsillitis 3 8 11 15

Total 14 21 24 12 74 100

Bronchitis accounted for 47%

Conclusions

• High resistance to co-trimoxazole• Treatment regimen: antibiotics used

invivo in line with the results invitro• Results of AMR surveillance programme

is very useful in preparing treatment guidelines

• Interventions are needed for the rational use of antibiotics