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Urine Antibiotic Activity in Patients Presenting to Hospitals in Laos: Implications for Worsening Antibiotic Resistance
Manisone Khennavong
Manisone Khennavong
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Viengmon Davone
Viengmon Davone
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Manivanh Vongsouvath
Manivanh Vongsouvath
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Rattanaphone Phetsouvanh
Rattanaphone Phetsouvanh
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Joy Silisouk
Joy Silisouk
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Olay Rattana
Olay Rattana
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Mayfong Mayxay
Mayfong Mayxay
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Josée Castonguay-Vanier
Josée Castonguay-Vanier
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Catrin E. Moore
Catrin E. Moore
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Michel Strobel
Michel Strobel
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Paul N. Newton
Paul N. Newton
Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR; Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
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Widespread use of antibiotics may be important in the spread of antimicrobial resistance. We estimated the proportion of Lao in- and outpatients who had taken antibiotics before medical consultation by detecting antibiotic activity in their urine added to lawns of Bacillus stearothermophilus, Escherichia coli, and Streptococcus pyogenes. In the retrospective (N = 2,058) and prospective studies (N = 1,153), 49.7% (95% confidence interval [CI] = 47.4–52.0) and 36.2% (95% CI = 33.4–38.9), respectively, of Vientiane patients had urinary antibiotic activity detected. The highest frequency of estimated antibiotic pre-treatment was found in patients recruited with suspected central nervous system infections and community-acquired septicemia (both 56.8%). In Vientiane, children had a higher frequency of estimated antibiotic pre-treatment than adults (60.0% versus 46.5%; P < 0.001). Antibiotic use based on patients histories was significantly less frequent than when estimated from urinary antibiotic activity (P < 0.0001).
Author Notes
Financial support: This study was funded by the Wellcome Trust of Great Britain and the AUF by the Francophone Institute for Tropical Medicine.
Disclosure: Most of this work was submitted by Manisone Khennavong as an MSc thesis (Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR).
Authors' addresses: Manisone Khennavong, Francophone Institute for Tropical Medicine, Vientiane, Lao PDR; Wellcome Trust- Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; E-mail: manisonekhennavong@yahoo.com. Viengmon Davone, Manivanh Vongsouvath, Rattanaphone Phetsouvanh, Joy Silisouk, Olay Rattana, Josée Castonguay-Vanier, Catrin E. Moore, and Paul N. Newton, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK, E-mails: viengmon@tropmedres.ac, manivanh@tropmedres.ac, rattanaphone@tropmedres.ac, ta@tropmedres.ac, olay@tropmedres.ac, josee@tropmedres.ac, catrin@tropmedres.ac, and paul@tropmedres.ac. Mayfong Mayxay, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR, E-mail: mayfong@tropmedres.ac. Michel Strobel, Francophone Institute for Tropical Medicine, Vientiane, Lao PDR, E-mail: michel.strobel@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Sosa AJ, Byarugaba DK, Amábile-Cuevas CF, Hsueh P-R, Kariuki S, Okeke IN (eds), 2010. Antimicrobial Resistance in Developing Countries. New York: Springer.
-
2.
Okeke IN, Laxminarayan R, Bhutta ZA, Duse AG, Jenkins P, O'Brien TF, Pablos-Mendez A, Klugman KP, 2005. Antimicrobial resistance in developing countries. Part I: recent trends and current status. Lancet Infect Dis 5: 481–493.
-
3.
Okeke IN, Lamikanra A, Edelman R, 1999. Socioeconomic and behavioral factors leading to acquired bacterial resistance to antibiotics in developing countries. Emerg Infect Dis 5: 18–27.
-
4.
Arason VA, Kristinsson KG, Sigurdsson JA, Stefánsdóttir G, Mölstad S, Gudmundsson S, 1996. Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study. BMJ 313: 387–391.
-
5.
Blomberg B, Manji KP, Urassa WK, Tamim BS, Mwakagile DS, Jureen R, Msangi V, Tellevik MG, Holberg-Petersen M, Harthug S, Maselle SY, Langeland N, 2007. Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study. BMC Infect Dis 7: 43.
-
6.
Cars O, Högberg LD, Murray M, Nordberg O, Sivaraman S, Lundborg CS, So AD, Tomson G, 2008. Meeting the challenge of antibiotic resistance. BMJ 337: a1438.
-
7.
Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group, 2005. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 365: 579–587.
-
8.
Kamat VR, Nichter M, 1998. Pharmacies, self-medication and pharmaceutical marketing in Bombay, India. Soc Sci Med 47: 779–794.
-
9.
Lansang MA, Lucas-Aquino R, Tupasi TE, Mina VS, Salazar LS, Judan N, Limjoco TT, Nisperos LE, Kunin CM, 1990. Purchase of antibiotics without prescription in Manila, the Philippines. Inappropriate choices and doses. J Clin Epid 43: 61–67.
-
10.
Phetsouvanh R, Phongmany S, Soukaloun D, Rasachak B, Soukhaseum V, Soukhaseum S, Frichithavong K, Khounnorath S, Pengdee B, Phiasakha K, Chu V, Luangxay K, Rattanavong S, Sisouk K, Keolouangkot V, Mayxay M, Ramsay A, Blacksell SD, Campbell J, Martinez-Aussel B, Heuanvongsy M, Bounxouei B, Thammavong C, Syhavong B, Strobel M, Peacock SJ, White NJ, Newton PN, 2006. Causes of community-acquired bacteremia and patterns of antimicrobial resistance in Vientiane, Laos. Am J Trop Med Hyg 75: 978–985.
-
11.
Higa N, Sithivong N, Phantouamath B, Insisiengmay S, Miyazato T, Iwanaga M, 2004. Initial stage of hospital contamination with methicillin-resistant Staphylococcus aureus in Lao People's Democratic Republic. J Hosp Infect 56: 125–130.
-
12.
Iwanaga M, Sisavath L, Higa N, Honma Y, Kakinohana S, 1997. Emergence of methicillin resistant Staphylococcus aureus in Laos. Jap J Trop Med Hyg 25: 103–106.
-
13.
Iwanaga M, Toma C, Miyazato T, Insisiengmay S, Nakasone N, Ehara M, 2004. Antibiotic resistance conferred by a class I integron and SXT constin in Vibrio cholerae O1 strains isolated in Laos. Antimicrob Agents Chemother 48: 2364–2369.
-
14.
Stoesser N, Crook D, Newton PN, Moore CE, Phetsouvanh P, Jones N, 2009. Molecular characterization of ESBL phenotypes in a collection of E. coli isolates from Laos, 2004–2009. Poster at Federation of Infection Societies. 11–13 November 2009, Birmingham, UK.
-
15.
Yamashiro T, Nakasone N, Higa N, Iwanaga M, Insisiengmay S, Phounane T, Munnalath K, Sithivong N, Sisavath L, Phanthauamath B, Chomlasak K, Sisulath P, Vongsanith P, 1998. Etiological study of diarrheal patients in Vientiane, Lao People's Democratic Republic. J Clin Microbiol 36: 2195–2199.
-
16.
Paphassarang C, Tomson G, Choprapawon C, Weerasuring K, 1995. The Lao National Drug Policy: lesson along the journey. Lancet 345: 433–435.
-
17.
Sihavong A, Lundborg CS, Syhakhang L, Akkhavong K, Tomson G, Wahlström R, 2006. Antimicrobial self medication for reproductive tract infections in two provinces in Lao People's Democratic Republic. Sex Transm Infect 82: 182–186.
-
18.
Stenson B, Syhakhang L, Eriksson B, Tomson G, 2001. Real world pharmacy: assessing the quality of private pharmacy practice in the Lao People's Democratic Republic. Soc Sci Med 252: 393–404.
-
19.
Tomson G, Sterky G, 1986. Self-prescribing by way of pharmacies in three Asian developing countries. Lancet 8507: 620–622.
-
20.
Moore CE, Sengduangprachan A, Taojaikong T, Sirisouk J, Foster D, Phetsouvanh R, McGee L, Crook D, Newton PN, Peacock S, 2010. Enhanced determination of Streptococcus pneumoniae serotypes associated with invasive disease in Laos using a real-time PCR serotyping assay on cerebrospinal fluid. Am J Trop Med Hyg 83: 451–457.
-
21.
Rhodes J, Hyder JA, Peruski LF, Fisher C, Jorakate P, Kaewpan A, Dejsirilert S, Thamthitiwat S, Olsen SJ, Dowell SF, Chantra S, Tanwisaid K, Maloney SA, Baggett HC, 2010. Antibiotic use in Thailand: quantifying impact on blood culture yield and estimates of pneumococcal bacteremia incidence. Am J Trop Med Hyg 83: 301–306.
-
22.
Wu J-J, Chien ML, Lee N, Chou S-F, Wang H-M, Tsai WC, 1996. Microbiologic assay for detection of antimicrobial agents in urine. J Formos Med Assoc 95: 464–468.
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