About 60% all of human infections in the world are caused by zoonotic pathogens transmitted typically by direct contact to animals or through faecally contaminated foods. Smallholder farmers in rural and suburban Vietnam live in close contact with their livestock which exposes household members to zoonotic pathogens. Urinary Tract Infections (UTIs) constitute a common infection in both developing and developed countries and indications have been published that chickens could be a reservoir for the involved bacterial pathogens. Extra intestinal pathogenic E. coli (ExPEC) count for about 80% of these infections while Enterococcus faecalis (E. faecalis) count for 4-8 of the cases. The objectives in the project are to: 1: Investigate the aetiology of urinary tract infections in Vietnam. 2: Describe the pattern of antimicrobial resistance in the ExPEC and the E. faecalis associated with UTI in Vietnam. 3: Describe the genetic and phylogenetic relationship between ExPEC and E. faecalis isolated from UTI-patients urine and faeces and poultry raised around their household to investigate to what extend poultry constitute a major reservoir for these infections. This will be done by collection of urine samples from patients suffering from urinary tract infection at a hospital in the outskirt of Hanoi (Army Hospital 103, Ha Dong). Together with the urine sample a faecal sample from the patient will be collected and a questionnaire about symptoms, earlier treatment and in-depth information of contact to poultry will be obtained by trained nurses at the hospital. In cases where the isolated pathogen from the urine sample is ExPEC or E. faecalis, and the patient raises poultry in proximity of his/her household, the household will be visited and faecal samples will be collected from chickens in the household. From poultry samples the pathogen corresponding to the pathogen isolated from the patient’s urine sample will be isolated by culturing on SSI Enteric Media for detection of E. coli and on Slanetz & Bartley media for detection of E. faecalis. All microbiological analysis will be carried out at National Institute of Hygiene and Epidemiology (NIHE) in Hanoi by the main applicant in collaboration with trained laboratory technicians. Isolated strains will be brought to University of Copenhagen for molecular characterisation and comparison by MLST typing to determine possible transmission between poultry and humans within a household. Partners involved (NIHE and Army hospital 103) will benefit from the project by training within their field (E. g. the involved hospital staff will receive training in sample collection from patients, obtain increased knowledge of aetiology of urinary tract infections and knowledge of antimicrobial resistance important for optimising treatment. Involved laboratory staff at NIHE will receive training in culturing clinical samples on new media suitable for urine culturing; will gain increased knowledge about common patterns of antibiotic resistance and knowledge about transmission of pathogens from animals to humans). The outcome of the project will, besides providing knowledge about aetiology, patterns of antibiotic resistance, and risk factors of acquiring urinary tract infection in relation to poultry contact, contribute with new knowledge on the possible existence of new zoonoses which are of relevance and importance for developed- and in particular developing countries. Findings will be published in peer-review international journals and in popular articles. The research is in line with priorities of the participating Vietnamese and Danish institutions and supports Danish efforts in Vietnam to build capacity needed to combat zoonoses.
The role of Enterococcus spp. as pathogens has increased while the source(s) of infections often remains unclear. Enterococcus faecalis from patients suffering urinary tract infection (UTI) in Vietnam and from poultry living in close contact with the patients were characterized by phenotypic and in several molecular methods. The same type of E. faecalis was isolated from UTI patients and poultry originating from the same households. These findings are the first of their kind that suggest that poultry serve as a reservoir for E. faecalis associated with human infections.