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Title: Bacterial infection in children hospitalised with diarrhoea in the South of Vietnam
Author: Vu, Duong
ISNI:       0000 0004 7654 1954
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2018
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Paediatric diarrhoeal disease is major global health problem. The aetiological diagnosis of diarrhoeal disease is often complex due to the wide array of potential infectious agents, available diagnostic techniques and local resources. Bacterial associated diarrhoeal diseases are an increasing issue due to high burden of antimicrobial resistance (AMR). As a consequence of standard treatments for diarrhoea (i.e. ORS), diarrhoea mortality has been decreased globally. However, the use of antimicrobial therapy for infectious diarrhoea has become controversial as the disease is often self-limited and the epidemiology of AMR pathogens. Here, I estimated the prevalence of bacterial infection among children hospitalised with bloody/mucoid diarrhoea using routine standard methodology (microbial culture) and multiplex real-time PCR. Information regarding antimicrobial usage and the proxy outcome of the patient were recorded. Novel diagnostics and methods (Luminex xTAG GPP and whole genome sequencing) were used in comparison to routine standard methodology and to investigate the infecting agents in more detail. In this setting non-typhoidal Salmonella (NTS) has become the most common bacterial cause of diarrhoea in children; followed by Campylobacter and Shigella with a substantial rate of AMR observed among these three major enteric pathogens. In a high usage setting, antimicrobial treatment for children with diarrhoea contradicted the antimicrobial susceptibility profiles and appeared to prolong the duration of hospitalisation. Diarrhoeagenic E. coli (DEC) were commonly detected; however, most pathotypes were found in stool samples from both diarrhoeal and non-diarrhoeal children. Only enteroinvavise E. coli (EIEC)/Shigella infections were significantly associated with diarrhoea. The xTAG GPP assay provided high sensitivity and specificity and was valuable for detecting other enteric pathogens which were not diagnosed by routine laboratory. S. Typhimurium was determined the most frequent NTS serovar via genoserotyping and were associated with an array of AMR genes; especially blaTEM-95, qnrS1. In conclusion, future studies in Vietnam should focus on a more streamlined approach to the diagnosis of diarrhoeal disease, to provide greater clinical evidence for supporting better clinical decision making to reduce or stop empirical antimicrobial usage for paediatric diarrhoea.
Supervisor: Baker, Stephen Sponsor: NDM Tropical Network Fund
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available