Thomas Kesteman

Thomas Kesteman is a clinical microbiologist working at the Oxford University Clinical Research Unit in Hanoi since 2020. After having worked for medical non-governmental organizations in Afghanistan and Lebanon, and a PhD on the effectiveness of malaria control interventions in Madagascar, Thomas turned his focus back to antimicrobial resistance in low- and middle-income countries and medical microbiology in resources-limited settings. He is now leading OUCRU’s research programme on the clinical microbiology solutions for rural hospitals to control antimicrobial resistance. His other research interests also encompass the aetiology of respiratory infections, epidemiology and genomic surveillance of SARS-CoV-2, social inequities in health access and behaviours, and vector-borne diseases. These all have one thing in common, they aim at tackling global inequities in infectious diseases.

Thomas’s research programme on the impact of clinical microbiology on antimicrobial resistance control in rural hospitals aims at evaluating whether different laboratory solutions are feasible and acceptable, and their impact in AMR perception by healthcare workers, in clinical management of infectious diseases, in the effectiveness of AMS programs, in antibiotic use, and in AMR surveillance at district hospital (DH) level. It involves quantitative, qualitative, and mixed methods, as well as implementation research design.

Context: In low- and middle-income countries (LMIC), the access to diagnostic capacity is particularly limited at the peripheral level, despite WHO’s recommendations. In Vietnam, less than 10% of district hospitals (DH) are equipped with microbiology labs. In the other DHs, clinicians either have to refer all patients suspected of having bacterial infection to the next level, or only provide empirical antimicrobial therapies. Some important aspects of antimicrobial stewardship (AMS), such as antibiotic de-escalation, rely on microbiology lab results. Moreover, district hospitals are unable to provide AMR data for surveillance or for adapting treatment guidelines to local AMR patterns. Thus, extending the coverage of labs to the peripheral level could be a key tool in AMR control, but the cost and complexity of clinical microbiology precluded most resource-limited countries from implementing microbiology testing.

Nevertheless, adapted laboratory solutions for LMIC exist. One of these solutions is a small scale, standalone, and cheap clinical bacteriology laboratory called Mini-Lab. Another solution is to organize the transport of samples from DH to a centralized laboratory, e.g. the nearest provincial hospital, and the communication of results from the lab to the DH in a timely manner. Other ready-to-use microbiology solutions will be considered whenever possible.