To characterise the clinical features of Acinetobacter baumannii infections and investigate the phylogenetic structure and transmission dynamics of A. baumannii in Vietnam. Between 2019 and 2020, a surveillance of A. baumannii (AB) infections was conducted at a tertiary hospital in Ho Chi Minh City, Vietnam. Risk factors for in-hospital mortality were analysed using logistic regressions. Whole-genome sequence data were used to characterise genomic species, sequence types (STs), antimicrobial resistance genes, surface antigens, and phylogenetic relatedness of AB isolates. Eighty-four patients with AB infections were enrolled in the study, 96% of whom were hospital-acquired. Half of the AB isolates were identified from ICU-admitted patients, while the remaining isolates were from non-ICU patients. The overall in-hospital mortality was 56%, with associated risk factors including advanced age, ICU stay, exposure to mechanical ventilation/central venous catheterization, pneumonia as source of AB infection, prior use of linezolid/aminoglycosides, and AB treatment with colistin-based therapy. Nearly 91% of isolates were carbapenem-resistant; 92% were multidrug-resistant; and 6% were colistin-resistant. ST2, ST571, and ST16 were the three dominant carbapenem-resistant A. baumannii (CRAB) genotypes, exhibiting distinct AMR gene profiles. Phylogenetic analysis of CRAB ST2 isolates together with previously published ST2 collection provided evidence of intra- and inter-hospital transmission of this clone. Our study highlights a high prevalence of carbapenem resistance and multidrug resistance in A. baumannii and elucidates the spread of CRAB within and between hospitals. Strengthening infection control measures and routine genomic surveillance are crucial to reducing the spread of CRAB and detecting novel pan-drug-resistant variants in a timely fashion.

In recent years, there has been increased attention on the importance of healthcare environmental cleaning, including the need to professionalize and support the workforce responsible for performing cleaning. Global agendas and strategies on infection prevention and control (IPC) and water, sanitation and hygiene highlight the need for improvements to this sector, particularly in resource-limited healthcare facilities in low- and middle-income countries. Correspondingly, several resources have been developed that aim to (1) improve professional training of cleaners and (2) improve implementation of best practices in resource-limited settings. This commentary seeks to provide insight into the barriers and facilitators to implementing these resources, drawing on the practical experience from two initiatives across four countries from 2018 through 2023. Several common barriers were identified across the diverse settings, including (1) low empowerment and status of the workforce, (2) low pay, inadequate staff time for the high workload needed to achieve best practices and high turnover of staff, and (3) a lack of connection and integration of environmental cleaning with IPC and patient safety efforts at the participating hospitals. Despite barriers, local teams identified effective mitigation measures. While considerable time and effort will be needed to truly overcome these barriers, there are opportunities to build upon attention and momentum on this topic and IPC initiatives in resource-limited settings in low- and middle-income countries. We propose several broader actions, all of which require local leadership and context-specific approaches.

Background: Klebsiella pneumoniae is a dangerous pathogen, responsible for a variety of infections and has been growing resistance to antibiotics, making it difficult to treat diseases caused by this bacterium. A better understanding of the phenotypic and genotypic characteristics of this bacterium is essential for developing more effective treatments. This study examines the prevalence of Klebsiella pneumoniae in patient samples from eight hospitals in Ho Chi Minh City, Vietnam, in 2023, focusing on its AmpC β-lactamase, ESBL, and carbapenemase genotypes. Methods and Results: A total of 230 Klebsiella pneumoniae strains were isolated from clinical specimens, including sputum, pus, urine, bronchial lavage fluid, blood, and other fluids. The disk diffusion method detected the presence of these resistance enzymes, while multiplex real-time PCR identified the associated genes. Results showed that 78.7% of isolates produced AmpC β-lactamase, 21.3% produced ESBL, and 27.0% produced carbapenemase. ESBL-producing strains (90.9%) were more common than AmpC (67.4%) and carbapenemase (45.7%) strains. Additionally, 27.0% of isolates produced multiple resistance enzymes. The most prevalent AmpC gene was DHA (63.5%), while SHV (84.3%), TEM (55.2%), and CTX-M (70.0%) were the most common ESBL genes. OXA-48 (31.3%) was the dominant carbapenemase gene, followed by NDM1 (24.8%) and KPC (9.1%). On average, each strain carried 3.3 resistance genes. Conclusions: This study reveals a high prevalence of antimicrobial resistance in Klebsiella pneumoniae isolates from patient samples in Ho Chi Minh City hospitals, notably to third-generation cephalosporins and carbapenems. These findings highlight the need for ongoing surveillance and improved treatment strategies.

Pseudomonas aeruginosa is a prevalent nosocomial pathogen known for its extensive antibiotic resistance. The overexpression of antibiotic efflux systems plays crucial role in the resistance patterns of this bacterium. Nevertheless, studies on the prevalence of efflux pump overexpression in P. aeruginosa in Vietnam remain limited. From May to July 2023, all strains suspected to be P. aeruginosa were collected from inpatents at the University Medical Center of Ho Chi Minh City, and Le Van Thinh Hospital, Ho Chi Minh City, Vietnam. After identification, the antibiotic susceptibility of these isolates were determined. Finally, the prevalence of overexpression of the MexAB-OprM, MexCD-OprJ, MexEF-OprN, and MexXY- OprM efflux systems were determined using the phenotypic method. The relationship between certain efflux pump overexpression and sampling sites or the antibiotic resistance profiles of these strains was analyzed using the Chi-squared test. Sixty isolated P. aeruginosa strains exhibited high rates of resistance to commonly used antibiotics, including ceftazidime (38.33%), cefepime (40.00%), meropenem (56.67%), imipenem (65.00%), gentamycin (41.67%), amikacin (31.67%), ciprofloxacin (45.00%), and levofloxacin (50.00%). The efflux pump MexEF-OprN was the most frequently overexpressed, found in 32/60 strains (53.33%), followed by MexCD-OprJ, which was overexpressed in 13/60 strains (21.67%). The overexpression of MexAB-OprM and MexXY-OprM were less common, detected in 6/60 strains (10.00%) and 3/60 strains (5.00%), respectively. MexEF-OprN overexpression was associated with the resistance patterns of these isolates. the current study was successful in determining the prevalence of efflux pump overexpression in clinical P. aeruginosa strains collected at multiple hospitals in Ho Chi Minh City.

Carbapenem-resistant Enterobacteriaceae (CRE) infection is an urgent threat to public health. The impact of CRE infection includes increased difficulty in treatment, and a high risk of death. intensive care unit (ICU) patients are particularly vulnerable to CRE infection due to severe illness and comorbidities,. This study aims to determine the prevalence of CRE infection and identify associated factors in the ICU setting. This cross-sectional study was conducted at a tertiary-level hospital, utilizing patient medical records to gather data. The study population included patients aged 18 and above who were treated in the ICU between July and December 2022. The data includes epidemiological and clinical characteristics, and CRE infection. During this period, 451 patients were included in the analysis. The key findings regarding the prevalence of CRE infection and associated factors are as follows. Prevalence of CRE infection among the patients was 28.8%. Patients with surgical site infection had a 1.40 times higher prevalence of CRE infection (p<0.007, 95% CI 1.09–1.77). For every 1 unit increase in hospitalization time within the last 3 months, APACHE II score, and hospitalization time, the prevalence of CRE infection increased by 1%–3%. For every 1 unit increase in sequential organ failure assessment score, the prevalence of CRE infection decreased by 8% with p=0.042 (95% CI 0.85–0.99). This high prevalence underscores the significant threat CRE poses in critical are settings and emphasized the urgent need for stringent infeciton control practices, including a prompt assessment of the patient’s health condition before admission to the hospital.

Background/Objective: Hirschsprung-associated enterocolitis (HAEC) can occur before and after surgery, increasing the complication rates, hospital stay, and treatment costs. This study aims to determine the incidence of preoperative and postoperative Hirschsprung-associated enterocolitis HAEC and the related risk factors. Methods: This study is a prospective cohort study of Hirschsprung’s disease patients under 16 years of age at two Children’s Hospitals in Ho Chi Minh City, Vietnam from December 2022 to June 2024. The postoperative follow-up is 12 months. Results: We enrolled 84 pediatric patients, with a male-to-female ratio of 5.4/1 and an average age of 7.2 ± 1.07 months. Of the patients, 25% had preoperative enterocolitis at the time of admission. Statistical analysis revealed that risk factors for preoperative enterocolitis at admission included a history of enterocolitis (p = 0.024), low weight in hospital (p = 0.001), and lack of preoperative treatment (p = 0.01). Postoperative enterocolitis occurred in 14 patients (16.7%) at an average of 4.03 months postoperatively. Multiple logistic regression of postoperative enterocolitis was associated with a history of preoperative enterocolitis (p < 0.001), anastomotic stricture (p = 0.002), and the length of the aganglionic segment (p = 0.031). No statistically significant association was found between the surgical method and the risk of postoperative enterocolitis. Conclusions: A history of preoperative enterocolitis, low weight, and anastomotic stricture are significant risk factors for postoperative enterocolitis in patients with Hirschsprung’s disease. Therefore, preoperative medical treatment is recommended for the patients who have not yet undergone a definitive surgical procedure.