Assessing the situation of AMR of bacteria in Vietnam, determining genomic characteristics and associated factors of common AMR-bacteria in Vietnam

抗菌素耐药性（AMR）被认为是21世纪人类面临的最大全球威胁。AMR已成为全球健康问题的中心，但大多数非专业人士不知道AMR将对全球人口产生的影响，以及AMR将如何影响2020/2025年的国际社会。首相大卫卡梅隆、英国首席医疗官（萨莉·戴维斯教授）和美国总统巴拉克·奥巴马最近的声明清楚地表明，这开始吸引英国和国际科学和政治的关注。此外，世界卫生组织最近公布了一项关于区域能力和东南亚（包括越南）的绘图工作，其中缺乏关于多重耐药的许多基本报告结构。因此，为了与“一个世界卫生”的总体概念保持一致，显然需要在“发达世界”和中低收入国家之间更好地协调和接触。在越南进行了关于AMR的特别研究;然而，其中大多数研究数量很少，重要的是没有融合临床和基础科学数据。已经完成的那些研究倾向于仅关注耐药机制，例如，称为NDM-1的碳青霉烯（用于最后手段感染的青霉素样化合物）耐药机制。尽管NDM-1现在存在于越南，并导致抗生素治疗失败，无疑会影响死亡率，但我们对其真正的影响或任何其他类型的AMR机制知之甚少。到目前为止，越南的研究是零星的，缺乏有意义的临床数据来真正归因于AMR等风险因素。该应用程序通过以下方式解决这些知识差距：1。对越南的感染和抗生素耐药性问题采取综合办法。该应用的独特之处在于，它将临床流行病学与分子生物学（全基因组测序）相结合，以评估AMR对越南患者的影响。我们已经选择了四个越南医疗中心，我们将在那里雇用和培训工作人员，在征得伦理同意后收集临床数据。国家卫生和流行病学研究所将进行抗生素耐药性测试和基础分子生物学。这种研究感染的综合方法不仅在越南而且在东南亚都是第一次。2.在越南提供有意义的基础设施和可持续的卓越研究。英国实验室将购买一台测序仪，越南研究人员将前往英国接受测序和生物信息学培训;在两年期结束时，测序仪将安装在越南，提供必要的分子基础设施。越南研究员将配备在越南独立进行基因组测序的设备。3.建立越南国家AMR监测网络。该申请还寻求根据世卫组织“同一个世界卫生”的口号建立一个国家抗菌素耐药性网络。这种全面而独特的方法将确定感染和AMR的风险因素，并允许确定对死亡率产生积极影响的干预措施。4.改善越南的患者福利。本研究的数据将确定感染和AMR风险最高的患者组。这些群体可以根据年龄（婴儿与成人）、社会经济地位（住房类型、卫生水平）、工作类型（农民、医院工作人员等）来划分。等等，但将为识别高风险患者群体提供有意义的数据。通过了解这些风险因素，我们将能够实施干预措施，从而改善患者护理。在英国，我们将与我们的越南同事密切合作，通过社交媒体和基于网络的沟通门户网站确保密切沟通和参与。我们还将建立一个越南公众教育计划（用越南语和法语编写），以接触到不了解越南AMR问题的当地人。

Antimicrobial resistance (AMR) is now deemed to be the biggest global threat facing humanity in the 21C. AMR has taken center stage as a global health issue yet most non-specialists are unaware the impact AMR will have on global populations, and how AMR will effect international communities in 2020/2025. Recent announcements from Prime Minister David Cameron, the UK Chief Medical Officer (Professor Sally Davies), and the US president, Barak Obama, is clear evidence that this starting to attract UK and international scientific and political traction. Additionally the World Health Organization recently published a mapping exercise on regional capacity and SE Asia, including Viet Nam lacked many basic reporting structures on multiple drug resistance (MDR). Therefore in keeping with the general notion of "One World Health" there clearly needs to better alignment and engagement between the "developed world" and low-middle income countries. There have been ad-hoc studies on AMR in Viet Nam; however, the majority of these are small in number and importantly do not blend clinical and basic scientific data. Those studies that have been done tend to focus only on a resistance mechanisms such as, for example, the carbapenem (penicillin-like compounds used in last resort infections) - resistant mechanism called NDM-1. Despite the fact that NDM-1 is now present in Viet Nam and causing antibiotic failures and no doubt impacting on mortality we know very little of its true impact, or indeed any other type of AMR mechanism. Thus far studies in Viet Nam have been sporadic and lack meaningful clinical data to truly attribute risk factors such as AMR. This application addresses these knowledge gaps by undertaking the following: 1. Comprehensive approach to the problem of infection and AMR in Viet Nam. This application is unique in that it combines clinical epidemiology with molecular biology (whole genome sequencing) to assess the impact of AMR in patients in Viet Nam. We have selected four Vietnamese medical centres where we will employ and train staff to collect clinical data following ethical consent. The National Institute of Hygiene and Epidemiology will carry out antibiotic resistance testing and basic molecular biology. This comprehensive approach to studying infections is the first of its type in not only Vietnam but also SE Asia. 2. Provide meaningful infrastructure and sustainable research excellence in Viet Nam. The UK lab will purchase a sequencer and the Vietnamese research fellows will travel to the UK and train in sequencing and bioinformatics; at the end of the two-year period the sequencer will be installed in Viet Nam providing essential molecular infrastructure. The Vietnamese research fellows will be equipped to independently run genomic sequencing in Viet Nam. 3. Establish a Vietnamese national AMR surveillance network. This application also seeks to implement a national AMR network in accordance with the WHO "one world health" mantra. This comprehensive and unique approach will identify risk factors for infection and AMR, and allow identification of interventions positively impacting on mortality. 4. Improving patient welfare in Viet Nam. The data from this study will identify groups of patients most at risk from infections and AMR. These groups could be based on age (infant versus adult), socio-economic status (type of dwelling, level of sanitation), type of job (farmer, hospital worker etc.) etc. etc. but will provide meaningful data for identifying high-risk patient groups. By understanding these risk factors we will be able to implement interventions resulting in better patient care. In the UK we will very closely with our Vietnamese colleagues to ensure close communication and engagement through social media and web-based communication portals. We also will establish a Vietnamese public education program (written in Vietnamese and French) to reach local people unaware of AMR issues in Viet Nam.