Ph.D.
Vu Thi Lan Huong
Oxford University Clinical Research Unit – Ha Noi
Title: Dynamics of Carbapenem-Resistant Enterobacterales Carriage and Resistance from Admission to Discharge: A Prospective Cohort Study in Vietnam
Name(s): Vu Thi Ngoc Bich1, Lam Thi Ngoc Kim2, Le Quang Tho3, Pham Thi Ngoc Thu2, Phan Vu Thu Ha3, Nguyen Thi Kha Tu2, Nguyen Quoc Phuong4,5, Nguyen Hai Yen1, Nguyen Thi Hong Ngoc1, Vu Thi Ngoc Anh1, Le Quynh Trang1,5, Chau Minh Duc6, Vo Thi Hoang Dung Em6, Phan Van Be Bay6, Le Na8, Trieu Quoc Thuong8, To Duc Linh8, Ngo Van Thuyen9, Nguyen Van Khoe10, Tran Quang Hong11, Le Van Hoang12, Tran Van Cuong13, Nguyen Anh Vu14, Luong Duy Dong15, Nguyen Thanh Manh16, Vi Quoc Huong17, Nguyen Tien Doan18, Vu Tien Viet Dung1, Tran Van Giang4,5, Pham Ngoc Thach4, Pham Thanh Duy1, Guy Thwaites5, Marc Choisy1,5, H Rogier van Doorn1,5, Vu Thi Lan Huong1
On behalf of the ASPARNet (Evaluating Antimicrobial Stewardship strategies and capacity building through Participatory Action Research and a Network approach in Vietnam) Study Group.
1 Oxford University Clinical Research Unit, Vietnam;
2Dong Thap Department of Health, Vietnam;
3Phu Tho Department of Health, Vietnam;
4National Hospital for Tropical Diseases, Vietnam;
5Hanoi Medical University, Vietnam;
6University of Oxford, UK;
7Dong Thap General Hospital, Vietnam;
8Phu Tho Provincal Hospital, Phu Tho, Vietnam;
9Sa Dec General Hospital, Vietnam;
10Thap Muoi Regional General Hospital, Vietnam;
11Cao Lanh 2 Health Center, Vietnam;
12Lap Vo Health Center, Vietnam;
13Thanh Binh Health Center, Vietnam;
14Phu Tho Regional General Hospital, Vietnam;
15Ha Hoa Health Center, Vietnam;
16Cam Khe Health Center, Vietnam;
17Thanh Ba Health Center, Vietnam;
18Thanh Thuy Health Center, Vietnam
Carbapenem-resistant Enterobacterales (CRE) are a global health threat, but gastrointestinal carriage remain poorly characterised, particularly in non-ICU patients. We aimed to quantify CRE acquisition and clearance from admission to discharge and identify associated risk factors. We conducted a prospective multi-centre cohort study of 2000 patients admitted to 12 Vietnamese hospitals. Rectal swabs at admission and discharge were cultured on CHROMagar™ mSuperCARBA™ media; suspected CRE colonies identified by MALDI-TOF MS, and underwent disc-diffusion antimicrobial susceptibility testing following CLSI 2025 guidelines. We used multistate and multivariable models to assess acquisition, clearance, and risk factors. CRE carriage increased from 18.1% at admission (362/2000) to 36.1% at discharge (687/1904). Overall, 23.2% of patients negative at admission were positive at discharge, whereas 6.2% positive at admission were negative at discharge. Early antibiotic exposure increased acquisition hazards for both carbapenem-resistant Escherichia coli (CREC) (HR:1.14, 95%CI: 1.07-1.21) and carbapenem-resistant Klebsiella pneumoniae (CRKP) (HR:1.18, 95%CI: 1.07-1.29). Additional risk factors for CRKP included severe renal disease (HR:3.62) and admission to provincial hospitals (HR:2.59). At admission, CREC carriage was associated with chronic pulmonary disease (OR:2.76) and diabetes (OR:2.41), whereas CRKP carriage was strongly associated with prior antibiotic use (OR:3.18). CREC showed faster acquisition and slower clearance than CRKP. CREC acquisition occurred at an estimated rate of 0.061 per day (95%CI: 0.053-0.070), corresponding to mean acquisition time of 16.3 days, while clearance was 0.091/day (95%CI: 0.072-0.114), corresponding to a mean clearance time of 11.0 days. CRKP acquisition was 0.020/per day (95%CI: 0.015-0.026; mean acquisition time 50.6 days), and clearance was 0.161/day (95%CI: 0.108-0.239; mean clearance time 6.2 days). In conclusion, hospitalization is an active period of CRE acquisition and clearance with distinct species-specific dynamics, with antibiotic exposure as a dominant driver of acquisition. Early antimicrobial stewardship actions, alongside infection prevention and control, are essential to reduce hospital-associated CRE acquisition.
Biography of the presenting author
Vu Thi Lan Huong completed her PhD in 2017 from University of Oxford and postdoctoral studies from Oxford University Clinical Research Unit (OUCRU Hanoi). Her work focuses on antimicrobial resistance, epidemiology, and implementation science. Her research interests are antimicrobial resistance, infection prevention and control, behaviour change interventions, digital tools, and antimicrobial stewardship.
Presenting author details
Full name: Vu Thi Lan Huong
Contact number: +84 946908912
Email: huongvtl@oucru.org
LinkedIn: www.linkedin.com/in/huong-vu-38204a2aa/
Researchgate: www.researchgate.net/profile/Huong-Vu-28?ev=hdr_xprf
Google Scholar: scholar.google.com/citations?user=mcvBFlgAAAAJ&hl=en
ORCID: 0000-0002-9579-5576
Website: https://www.tropicalmedicine.ox.ac.uk/team/vu-thi-lan-huong
Session name/ number: Antimicrobial resistance and treatment/2.
Category: (Oral presentation)