The Viet Nam Resistance Project Tackles Looming Antibiotic Crisis
Researchers are collaborating with 16 hospitals in Vietnam to strengthen national evidence-based control of antibiotic use in the country.
AsianScientist (Jun. 14, 2013) - Vietnam has long contended with the widespread resistance to antibiotics but this may soon be resolved by a multinational project that aims to control the spread of infection and inappropriate use of antibiotics.
The Viet Nam Resistance Project (VINARES), a collaborative project between international health research groups and the Vietnamese medical sector, was launched in late 2012 to develop the country's capacity to stem antibiotic resistance over the long term.
Researchers at Oxford University Clinical Research Unit (OUCRU) in Hanoi and the Sweden-based Linköping University (LiU) linked up with 16 of the country's biggest hospitals including the National Hospital for Tropical Diseases and National Hospital for Pediatrics, the Vietnamese Association for Infectious Diseases, and the Vietnamese Health Ministry to implement this project.
To date, the project has received US$700,000 in funding from LiU, the Swedish International Development Cooperation Agency, Wellcome Trust, and the Global Antibiotic Resistance Partnership (GARP).
Speaking to Asian Scientist Magazine, VINARES project coordinator Håkan Hanberger said that the most significant gain from the project is to "provide impetus and tools to support development of an effective antimicrobial stewardship program" for Vietnam.
Hanberger said VINARES bridged the "know-do" gap that often plagues implementation of health initiatives in Vietnam – a problem that it shares with most emerging economies which have ambitious healthcare policies but lack the funding or training to implement them.
In 2010, a situation analysis prepared by GARP identified three reasons behind high resistance rate in Vietnam: sub-optimal infection control, inadequate laboratory diagnostic capacity, and inappropriate antibiotic therapy as important. Also, a study published January 2012 in the journal Antimicrobial Agents and Chemotherapy (AAC) showed that resistance to erythromycin, an antibiotic used against bacteria that caused pneumonia and bronchitis, was very prevalent in Asia. The highest resistance rates were recorded in China (96.4 percent), Taiwan (84.9 percent), and Vietnam (80.7 percent).
A recent study published in PLoS Medicine that was co-authored by Heiman Wertheim, clinical microbiologist and head of OUCRU, notes that antibiotic resistance is partly the result of "a dysfunctional health system."
"Long-term commitment is necessary to improve healthcare infrastructure in order to establish a successful antibiotic stewardship programme and reduce resistance rates," Wertheim said in his report.
In an interview with Asian Scientist Magazine, Wertheim, who has done extensive studies on infectious diseases in Vietnam and other Asian countries, said Southeast Asia "is in general a hotspot for resistance." He attributed this to high population density, livestock density (to feed many people), uncontrolled access to antibiotics, poor infection control, and a lack of sanitation.
Separately, Hanberger told Asian Scientist Magazine that pilot studies of intensive care units (ICUs) in several Vietnamese hospitals revealed a "very high rate of antibiotic resistance." This, he said, helped them to identify urgent needs for improvement and to implement VINARES. He added that LiU decided to partner with OUCRU given their extensive experience in Vietnam.
VINARES was launched to spread awareness about antibiotics
In September 2012, VINARES was formally launched through workshops held in Hanoi and Ho Chi Minh City which gathered directors, clinicians, infection control doctors, microbiologists and pharmacists from the participating hospitals. These workshops resulted in a division into three sub-projects: infection control, antibiotic consumption, and microbiological analysis. Wertheim said that a lot of people are not aware what an antibiotic is and often misused it. This is why it is important to create awareness and make doctors and hospitals responsible for the antibiotic resistance.
"This project (VINARES) supports the prudent use of antibiotics. It requires everyone to contribute and act in unison. Most hospitals work in silos and wait for leaders to direct them. We all need to step up and this projects gives them the tools to kickstart it," Wertheim said.
Several months after the first workshops on infection control, healthcare and antibiotic consumption were held in Hanoi and Ho Chi Minh City, VINARES helped to create a centralized database for the formulation and implementation of health care policies and surveillance, as well as upgrade laboratories and train Vietnamese doctors, clinicians, and health professionals on problem-based learning and infection control. VINARES researchers are also working on treatment guidelines for intensive care units that can support them in choosing the right antibiotic.
Wertheim added that a new website will be launched in July where various tools and protocols will be made available freely. The project will end by December 2013, he said, and by the end of this project, they hope to have created awareness with leading hospitals across Vietnam. He also expects that surveillance structures for resistance, antibiotic use, and hospital acquired infections will be in place.
"We hope that our Vietnamese partners will see the value of these structures and keep these running," he said.
Copyright: Asian Scientist Magazine; Photos: Linköping University.
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