Problems posed by drug-resistant bacteria are becoming more serious. Increasingly, doctors are having more difficulties treating cases, patients must spend more time in hospital and more medicines are being administered – and in many instances, care is ineffectual and the patient dies. Due to these factors, Ho Chi Minh City Infection Control Society is cooperating with FV Hospital to organise the scientific seminar “Bacterial resistance: problems and solutions”.

The seminar took place on March 2 and March 3, 2018, chaired by Acting Director of FV Hospital Dr Henri Maries, with the participation of doctors from around the country, including:

• Mr Fazli Shuib, Head of Pharmacy at FV Hospital
• Dr Louis Kreitmann, Head of ICU at Hospital Civil de Lyon
• Dr Friend Maviza, Head of Laboratory & Blood Bank of FV Hospital
• Dr Duong Bich Thuy, Vice President of ICU at the Hospital of Tropical Diseases of HCMC
• Assoc. Prof. Lê Anh Thư, MD, PhD, Chairman of Ho Chi Minh City Society of Osteoporosis.

Opening the seminar, Mr Shuib said that every year at least 700,000 people die from drug-resistant bacteria – that means every three seconds, a patient dies due to drug-resistant infections.

In Asia, Vietnam is a hot spot. Therefore, urgent work needs to be done to improve the situation, particularly with regards to collating data from clinical studies carried out by reputable organisations and rolling out antibiotics management programmes as strict as the one at FV Hospital.

Why does Vietnam have such as problem with drug-resistant bacteria? Dr Duong Bich Thuy from the A&E Department of the Hospital of Tropical Diseases offered an answer: Vietnamese people are familiar with the use of antibiotics. Every time they get a cold or fever, rather than see a doctor or take suitable medicines such as ibuprofen or acetaminophen, people visit a pharmacy where they can buy antibiotics easily.

This is the main reason for the formation of drug-resistant viruses such as: Acinetobacteria, Salmonellae and Pseudomonas.On the precautions of antibiotic resistance, Dr Thuy referred to cases of drug resistance in hospital and explained how some patients need to take medicine for a long time while being hospitalised, and in some cases are re-hospitalised after falling ill again upon returning home.

Dr Duong Bich Thuy shared clinical research documents from the Hospital of Tropical Diseases from 2014 to 2016, which surveyed 838 emergency patients, and noted 93 per cent of hospitalised patients had a bacterial infection, while 63 per cent of patients admitted presented with drug-resistant bacteria from prior stays.

Therefore, in order to solve the drug resistance of bacteria, the Hospital of Tropical Diseases strictly manages antibiotics through its Antimicrobial Stewardship Programme. All antibiotics prescriptions must be based on real health history, the epidemiology of patients and have undergone multiple levels of censorship.

Dr Louis Kreitmann, head of ICU of FV Hospital, presented an account of the antibiotic resistance problem from 2011 to 2016. His report added to the body of medical data regarding the issues of drug resistance in Vietnam. The data from the monitoring antibiotic center reported that since 2014, Asia and Africa account for over 50 per cent of deaths due to drug resistance, worldwide, with a high concentration of deaths occurring in Vietnam. Forecast to 2050, the number of deaths from infection by antibiotics-resistant pathogens will be higher than those due to serious diseases such as cancer and diabetes if there are no affirmative changes.

The seminar took place at FV Hospital with the participation of doctors from the other hospitals

From 2011 to 2016, research was undertaken at the Internal Medicine Department, Paediatrics Department and Emergency Care Unit at FV Hospital into four main groups of bacteria: E. coli (Escherichia coli), Staphylococcus aureus, Pseudomonas aeruginosa and Shigella SP.

Results showed that E.coli is up to 20 per cent resistant to all antibiotics, the same as in other Asian countries and much higher than European countries. Staphylococcus Aureus is up to 40 per cent resistant to antibiotics and Shigella SP, up to 30 per cent resistant.

In addition, the data also recorded that in 2013, strains of Shigella SP that originated in HCMC caused diseases in Hue and Khanh Hoa. This indicates the movement of bacteria to different regions.

In general, the data shows the resistance of Shigella SP is increasing. If we set a target that 80 per cent of treatments must be successful, the amount of effective antibiotics is still very small. The problem for the current state of the medical field in Vietnam is: choosing an effective type of antibiotic which does not have a negative long-time impact.

Next, the report of Chairman of Ho Chi Minh City Society of Osteoporosis, Assoc. Prof. Lê Anh Thư, MD, PhD, offered an update on the Global Guidelines for the Prevention of Surgical Site Infection. From Lancet statistics, every year there are around seven million instances of post-surgical complications around the world, which result in up to one million patient deaths. These numbers show that the risk of surgical site infection is very concerning.

In Vietnam, 32 per cent of infections acquired in hospital are surgical site infections, while in developed countries the figure is around one to five percent, and in the developing countries, 15 to 25 per cent. Dr Anh Thu explained how hygiene steps to prevent infection pre-, during and post-operation can help to avoid antibiotics abuse and improve safety while minimising deaths.

Last, Mr Friend Maviza head of Laboratory & Blood Bank at FV Hospital, introduced new technology for the early diagnosis of infection at FV Hospital: nested Multiplex PCR technology, Maldi Tof mass spectrometry and a new generation of blood transfusion equipment

FilmArray offers results quickly and accurately, reproducing 15 to 30 infectious diseases with a high degree of safety due to its closed system. Within one hour, it can immediately identify the cause of respiratory infections, septicaemia, encephalitis and meningitis, compared with the 24 to 72 hours required by traditional methods. This is significant as delays can lead to more inappropriate antibiotic use, lead to complications relating to treatment and higher rates of cost and patient deaths.

New equipment such as Vitek MS and VirtuO BacT/ALERT, along with rich data platforms such as Data V3, certified with CE/IVD, can help identify 1046 kinds of bacteria and fungus.

MYLA data helps to save time retrieving information, send emergency reports about blood transfusion cases, effectively measure the frequency of appearance of bacteria, and produce antimicrobial susceptibility reports quickly and reliably.In addition, Mr Friend Maviza also taked about the antibiotic management programme at FVH, currently a key project of FV, officially deployed in July 2017.

Doctors take photo after the seminar

At the close of the seminar, doctors had gained new knowledge about the issues of drug resistance in Vietnam and discussed the various problem-solving programmes that each hospital has launched.More importantly, each participant learned more about their responsibility when examining and treating patients, and to consider prescribing antibiotics more carefully with closer consultation with patients.The use of antibiotics in the right way, at the right time, at the right dose is the best way to avoid more long term issues.