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November 18 – 24 is World Antimicrobial Awareness Week. Antimicrobial resistance has been a key focus in OUCRU’s research for many years. Our objective is to understand and improve antimicrobial use and antimicrobial resistance in agriculture, the community, and hospitals. Our approach is interdisciplinary – led by a number of OUCRU’s research groups and public engagement teams.

Posters promoting antimicrobial awareness in Vietnam

Antimicrobial resistance (AMR) happens when bacteria, viruses, fungi, and parasites evolve over time to become resistant to medicine, making it more difficult to prevent and treat infections, and increasing the risk of disease spread, severe illness, and death.

OUCRU's Aims

Our current AMR research programme has the following five overarching aims:

  • To improve the impact of surveillance of drug-resistant infections using clinically oriented case-based hospital surveillance and whole genome sequencing;
  • To evaluate interventions to reduce antibiotic use and resistance at the community level, taking a OneHealth approach;
  • To continue our antimicrobial stewardship programmes at provincial-level hospitals and expand to district-level hospitals;
  • To conduct innovative clinical trials to evaluate treatment outcomes of drug-resistant infections;
  • To undertake Public and Community Engagement to understand and encourage appropriate antimicrobial use at the community level.

These efforts strive to curb antimicrobial use at the community level and in primary care settings to reduce antimicrobial resistance in AMR hotspots in Southeast Asia.

HANOI

In the Hanoi Unit, the research has included driving the situation analysis and development of a National Action Plan for AMR 2013-2020, and establishing a surveillance network of hospitals (VINARES) and a reference laboratory, both of which have been recognised by the Vietnamese Ministry of Health and received national status under Fleming Fund grants. OUCRU currently has a seat on the advisory panel to the Vietnamese Ministry of Health for the development and implementation of the National Action Plan for AMR 2021-2030.

In the last seven years, the Hanoi Unit has focused on applied descriptive and interventional studies on drug-resistant infections in ICU and community-based interventions to reduce use and resistance. These include using rapid diagnostics (C-Reactive Protein) and implementing and researching antimicrobial stewardship at provincial-level hospitals.

OUCRU Hanoi is a part of A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN), which aims to roll out clinical AMR surveillance as part of routine care in a network of hospitals across Asia and Africa and to collect microbiology and clinical data from 2,500 patients per site, which will expand on the sample-based approach of WHO GLASS and enable classification of infection syndromes, the origin of infection and outcome.

Since 2020 OUCRU Hanoi has been working on a ‘Photovoice about AMR’, a project with community members in the Red River Delta region, where the rate of antibiotic resistance is at the highest in Vietnam. Local women and farmers have developed skills to create photographs that tell the story of the current antimicrobial resistance situation through their eyes. The photos vividly and honestly reflect the situation of antibiotic use for humans and animals. Behind the photos are messages about the correct use of antibiotics to support good healthcare for families and animals, and building a healthier community together. These images and messages have been presented in exhibitions in 2020 and 2021.  

Now in 2022, in collaboration with the National Institute of Hygiene and Epidemiology, they are being presented at the Vietnamese Women’s Museum and online in the Photovoice about AMR Virtual Exhibition.

OUCRU Hanoi has also convened an AMR Youth Working Group in Nam Dinh as part of the YAAR Project, bringing together young people from four countries in the Global South to help combat the challenge of AMR. This group worked in schools to raise awareness of the issue and contributed to a short film made by and for young people in Vietnam on the issue.

HO CHI MINH CITY

In Ho Chi Minh City, the Unit has focused on bacterial drug resistance, developing clinical microbiology capacity in a wide spectrum of hospitals, drug-resistant infections in the ICU, resistance among enteric pathogens (Shigella and Salmonella Typhi), and at the human-animal interface (E. coli, non-Typhi Salmonella, S. suis). This has also included large-scale whole-genome and microbiome sequencing. In addition, part of the portfolio of the malaria and tuberculosis research groups is dedicated to drug-resistant infections, including treatment trials, whole genome sequencing, and more discovery-oriented research on resistance mechanisms and emergence. 

This unit also participated in the YAAR Project, creating a series of cartoons on the issue which were shared on social media, and contributing to a short film on the issue for young people in Vietnam.

INDONESIA

Over the past four years, OUCRU Indonesia has leveraged the existing expertise and networks in Vietnam and nurtured a closely aligned yet context-specific research programme. This includes mixed-method research to understand patterns and drivers of antibiotic prescribing in hospitals and identify opportunities for stewardship interventions. OUCRU Indonesia takes part in several large international projects that are delivered in both countries on AMR surveillance, antibiotic stewardship, and blood culture barriers.

Conducting these studies across the two countries in our programme and the wider Oxford Tropical Network allows for local tailoring and contextualisation. The collaboration between the two countries and the wider Oxford Tropical Network network enhances the generalisability and impact of results.

The full story is available on the OUCRU website

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