Thomas Kesteman

• MD, MPH, PhD
• Clinical Microbiologist at Oxford University Clinical Research Unit

Antibiotics were frequently prescribed for respiratory symptoms (56%), fever and fatigue (52%), and urinary tract symptoms (41%), with younger children receiving the lowest proportion of prescriptions compliant with guidelines (63%). 2. Lower compliance with antibiotic guidelines was observed • in patients <6 years old (OR: 0.35 [0.18-0.67]) • in p...

Klebsiella pneumoniae là một trong các tác nhân hàng đầu gây nhiễm trùng cơ hội trên người, với khả năng đề kháng nhiều loại kháng sinh, được tìm thấy trong môi trường, hệ đường ruột của người, động vật. Gene đề kháng colistin mcr-1 và mcr-3 là hai biến thể lưu hành phổ biến ở Việt Nam. Tuy nhiên, những hiểu biết về đặc điểm kháng colistin của các...

Ceftriaxone resistance in Neisseria gonorrhoeae is an escalating global health concern, threatening the efficacy of empiric treatment. In the Asia-Pacific region, a rapid surge in ceftriaxone resistance has been observed, primarily associated with the penA-60.001 allele. This study, conducted in Hanoi, Vietnam between 2023 and 2024, analyzed 352 N....

Background Antimicrobial resistance (AMR) is a silent pandemic causing 1.27 million deaths in 2019, disproportionately affecting low- and middle-income countries, but resistance among commensal microbiota and the determinants of carriage have not been widely reported. This cross-sectional household study aimed to determine the prevalence of carbape...

Background Beta-lactams remain the first-line treatment of Streptococcus pneumoniae infections despite the increasing global prevalence of penicillin-resistant/non-susceptible strains. We conducted a cross-sectional household survey in a rural community in northern Vietnam in 2018–2019 to provide prevalence estimates of penicillin non-susceptible S...

Background Madagascar has made significant progress in the fight against malaria. However, the number of malaria cases yearly increased since 2012. ITNs and IRS are key interventions for reducing malaria in Madagascar. Given the increasing number of cases and limited resources, understanding the cost-effectiveness of these strategies is essential f...

The first nationwide outbreak of COVID-19 in Vietnam started in late April 2021 and was caused almost exclusively by a single Delta lineage, AY.57. In early 2022, multiple Omicron variants co-circulated with Delta variants and quickly became dominant. The co-circulation of Delta and Omicron happened leading to possibility of co-infection and recomb...

The first nationwide outbreak of COVID-19 in Vietnam started in late April 2021 and was caused almost exclusively by a single Delta lineage, AY.57. In early 2022, multiple Omicron variants co-circulated with Delta variants and quickly became dominant. The co-circulation of Delta and Omicron happened leading to possibility of co-infection and recomb...

This study aimed at examining the impact of COVID-19 on acute respiratory infections (ARI) and antibiotic prescribing in primary care settings. We used secondary data from 64 commune health centers in Northern Vietnam from 2019 to 2022. Results: Number of visits and ARI cases sharply decreased during the Alpha and Delta waves, and remained lower th...

Carbapenem-resistant Enterobacterales (CRE) is a global public health threat with high mortality and limited effective treatments available. This is particularly problematic in low-and middle-income countries with uncontrolled use of antibiotics and lack of effective infection control practices. This study aims to understand clinical characteristic...

https://registration.eccmid.org/abstractlist.aspx?e=21&g=ad6f5689-9479-4d2c-b83b-404eeaa5a0f9&preview=1&aig=-1&ai=23468&stamp=RRG%2ffKLYwzcpJsC6VzTa%2fQ%3d%3d

Viral sequencing has been critical in the COVID-19 pandemic response, but sequencing and bioinformatics capacity remain inconsistent. To examine the utility of a cloud-based sequencing analysis platform for SARS-CoV-2 sequencing, we conducted a cross-sectional study incorporating seven countries in July 2022. Sites submitted sequential SARS-CoV-2 s...

In sub-Saharan Africa, despite the implementation of multiple control interventions, the prevalence of malaria infection and clinical cases remains high. The primary tool for vector control against malaria in this region is the use of long-lasting insecticide-treated nets (LLINs) combined or not with indoor residual spraying (IRS) to achieve a syne...

We analyzed 1,303 SARS-CoV-2 whole-genome sequences from Vietnam, and found the Alpha and Delta variants were responsible for a large nationwide outbreak of COVID-19 in 2021. The Delta variant was confined to the AY.57 lineage and caused >1.7 million infections and >32,000 deaths. Viral transmission was strongly affected by nonpharmaceutical interv...

In low- and middle-income countries (LMIC) such as Vietnam, most hospitals at the lower level hospitals do not have access to clinical microbiology diagnostics, which could hamper the global efforts of antimicrobial resistance (AMR) control 1. Therefore, adapted laboratory solutions for LMIC are an important area for further investigations and shou...

Objectives To investigate the feasibility of retrospective prescription-based review and to describe the antibiotic prescribing patterns to provide information for an antimicrobial stewardship programme in Viet Nam Methods This study was conducted in two provincial-level hospitals between February and April 2020. Reviews were done by a clinical te...

In 2021, Vietnam experienced a large nationwide outbreak of COVID-19, with over 1.7 million infections and 32,000 deaths. We generated 1,303 SARS-CoV-2 whole-genome sequences, and mapped out the public health measures alongside the evolutionary trajectory of the pathogen. The Alpha variant caused sporadic outbreaks in early 2021 prior to the upsurg...

Vietnam has high rates of antibiotic use and resistance. Measuring resistance in commensal bacteria could provide an objective indicator for evaluating the impact of interventions to reduce antibiotic use and resistance. This study aimed to evaluate the feasibility, acceptability, and bacterial recovery for different sampling strategies. We conduct...

Easy and robust antimicrobial susceptibility testing (AST) methods are essential in clinical bacteriology laboratories (CBL) in low-resource settings (LRS). We evaluated the Beckman Coulter MicroScan lyophilized broth microdilution panel designed to support Médecins Sans Frontières (MSF) CBL activity in difficult settings, in particular with the Mi...

Bloodstream infections (BSIs) are a leading cause of sepsis, a life-threatening condition that contributes significantly to the mortality of bacterial infections. Aminoglycoside antibiotics such as gentamicin or amikacin are essential medicines in the treatment of BSIs, but their clinical efficacy is increasingly compromised by antimicrobial resist...

Background Vietnam has high rates of antibiotic resistance, driven by overuse in agriculture, hospital, and community healthcare. Measures of resistance in commensal bacteria could provide a hard indicator for progress in evaluating the impact of interventions to reduce antibiotic use in the community. This study aimed to evaluate the feasibility,...

Background Vietnam has high rates of antibiotic resistance, driven by overuse in agriculture, hospital, and community healthcare. Measures of resistance in commensal bacteria could provide a hard indicator for progress in evaluating the impact of interventions to reduce antibiotic use in the community. This study aimed to evaluate the feasibility,...

Among 114 clinical Neisseria gonorrhoeae isolates collected in Vietnam during 2019-2020, we detected 15 of subclone sequence type 13871 of the FC428 clonal complex. Fourteen sequence type 13871 isolates with mosaic penA allele 60.001 were ceftriaxone or cefixime nonsusceptible, and 3/14 were azithromycin nonsusceptible. Emergence of this subclone t...

Background Manual blood culture bottles (BCBs) are frequently used in low-resource settings. There are few BCB performance evaluations, especially evaluations comparing them with automated systems. We evaluated two manual BCBs (Bi-State BCB and BacT/ALERT BCB) and compared their yield and time to growth detection with those of automated BacT/ALERT...

Objectives This study aimed to analyze the current state of antimicrobial stewardship (AMS) in hospitals in Viet Nam, a lower middle-income country, to identify factors determining success in AMS implementation and associated challenges to inform planning and design of future programs. Methods We conducted a mixed-methods study in seven acute-care...

Objectives To investigate the feasibility of establishing hospital-based antimicrobial stewardship (AMS) programmes comprising action-planning, educational interventions and data feedback in two provincial-level hospitals in Viet Nam. Design and setting This was an implementation research using participatory action process and existing resources f...

Background Routine microbiology results are a valuable source of antimicrobial resistance (AMR) surveillance data in low- and middle-income countries (LMICs) as well as in high-income countries. Different approaches and strategies are used to generate AMR surveillance data. Objectives We aimed to review strategies for AMR surveillance using routin...

Background In low-and–middle-income countries (LMIC), data related to antimicrobial resistance (AMR) are often inconsistently collected. Humanitarian, private, and non-governmental medical organizations (NGO), working with or in parallel to public medical systems, are sometimes present in these contexts. Yet, what is the role of NGOs in the fight a...

Background Although it is accepted that long-lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this research is to summarize recent qualitative studies describing LLIN...

Background Although it is accepted that long lasting insecticide bed net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; malaria prevalence is highest in this age group. The purpose of this article is to summarize recent qualitative studies describing LLIN us...

Background: Although it is accepted that long lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this article is to summarize recent qualitative studies describing LLIN...

Background: In low-malaria-transmission areas of Madagascar, annual parasite incidence (API) from routine data has been used to target indoor residual spraying at sub-district commune levels. To assess validity of this approach, we conducted school-based serological surveys and health facility (HF) data quality assessments in seven districts to co...

Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations...

Le risque de décès, d’aggravation d’une maladie ou d’endettement dans ses suites, dépend des dispositifs et moyens disponibles et accessibles à la population pour y faire face. Ainsi, la vulnérabilité liée au paludisme dépend des contextes socio-économique et géoclimatique qui déterminent le risque de transmission, des comportements individuels ou...

Abstract Malaria control programs implementing Long-Lasting Insecticidal Nets (LLINs) are encouraged to conduct field monitoring of nets’ survival, fabric integrity and insecticidal bio-efficacy. The reference method for testing the insecticide activity of LLINs needs 100 two-to-five-day-old female mosquitoes per net, which is highly resource-inten...

Background: The reduction of global malaria burden over the past 15 years is much attributed to the expansion of mass distribution campaigns (MDCs) of long-lasting insecticidal nets (LLIN). In Madagascar, two LUN MDCs were implemented and one district also benefited from a community-based continuous distribution (CB-CD). Malaria incidence dropped...

Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations...

Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementati...

Background Thanks to a considerable increase in funding, malaria control interventions (MCI) whose efficacy had been demonstrated by controlled trials have been largely scaled up during the last decade. Nevertheless, it was not systematically investigated whether this efficacy had been preserved once deployed on the field. Therefore, we sought the...

Background Because international funding for malaria control is plateauing, affected countries that receive foreign funding are expected to maintain a constant budget while continuing to reduce Plasmodium transmission. To investigate the appropriateness of a malaria control policy in Madagascar, the effectiveness of all currently deployed malaria c...

Background: Although its incidence has been decreasing during the last decade, malaria is still a major public health issue in Madagascar. The use of Long Lasting Insecticidal Nets (LLIN) remains a key malaria control intervention strategy in Madagascar, however, it encounters some obstacles. The present study aimed to explore the local terminolog...

Background - Madagascar, as other malaria endemic countries, depends mainly on international funding for the implementation of malaria control interventions (MCI). As these funds no longer increase, policy makers need to know whether these MCI actually provide the expected protection. This study aimed at measuring the effectiveness of MCI deployed...

BACKGROUND: The malaria burden in Madagascar dropped down last decade, largely due to scale-up of control measures. Nevertheless, a significant rise of malaria cases occurred in 2011-2012 in two regions of the rainy South-Eastern Madagascar, where malaria is considered as mesoendemic and the population is supposed to be protected by its acquired im...

The impact of migration and country or region of origin on sexual behaviours and prevention of the sexual transmission of HIV has been scarcely studied in France. The objective of this study was to evaluate if and how individual attitudes of prevention towards HIV infection are different according to country or region of origins in Paris area, Fran...

Background - In the last decade, an important scale-up was observed in malaria control interventions. Madagascar entered the process for pre-elimination in 2007. Policy making needs operational indicators, but also indicators about effectiveness and impact of malaria control interventions (MCI). This study is aimed at providing data about malaria i...

In a global context of international funding plateauing, control programs are looking for innovative options to better perform with a constant budget. In absence of groundbreaking new control tools, the only option is to make the best use of the control measures that are already available. In order to guide policy making, we propose to carry out a...

The impact of disease control can be either evaluated by a classical ecological study, or by multiplication of the effec-tiveness of control intervention and the disease burden. The latter approach has the advantage of circumventing ecological biases. To evaulate the effectiveness of the malaria control program implemented in Madagascar, we conduct...

Introduction The malaria burden in Madagascar dropped down last decade, largely due to scale-up of control measures. Nevertheless, a significant rise in cases was observed in the surveillance system in February, 2012 in Vatovavy Fitovinany and Atsimo Atsinanana regions. These are located in South-Eastern Madagascar, where malaria is considered as h...

Extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli (ESBL E. coli) strains are of major concern because few antibiotics remain active against these bacteria. We investigated the association between the fecal relative abundance (RA) of ESBL-producing E. coli (ESBL-RA) and the occurrence of ESBL E. coli urinary tract infections (UTIs)....

Background: In France in 2009, 60.1% of new HIV infections were related to heterosexual transmission and among those 68.1% happened in people born abroad. Nevertheless impact of migration and origins on sexual behaviors and prevention towards sexual transmission of HIV has been scarcely studied yet in France, partly because of the restriction in co...

Background. Escherichia coli is both a major commensal of the Human intestinal microbiota and the main causative agent of urinary tract infections (UTI). The faecal concentration of extended-spectrum beta-lactamases producing E. coli could be a new marker for predicting ESBL-E. coli infections such as UTI. Methods. Between October 2008 and March 20...

Bien que la population française soit actuellement mieux informée sur le VIH qu’au début de la pandémie, les comportements de prévention restent insuffisants. Dans ce contexte, notre objectif est d’estimer le poids relatif des caractéristiques démographiques et socioéconomiques, des comportements sexuels, et des facteurs contextuels dans la percept...

Borrelia burgdorferi sensu lato is a genetically diverse group of spirochetes that includes the agent of Lyme borreliosis in which genospecies tend to be associated with specific clinical features. The aim of the study was to determine the prevalence and genetic diversity of Borrelia burgdorferi sensu lato in 524 ticks collected in woods of a weste...

Infliximab is a human-murine chimeric monoclonal antibody directed against tumor necrosis factor alpha (TNFalpha). Infliximab and other TNF blockers are used to treat inflammatory diseases such as rheumatoid arthritis (RA). TNF blockers are suspected to play a key role in some infections. We report here two cases of Listeria monocytogenes sepsis as...

L’ehrlichiose est une maladie infectieuse de l’adulte transmise par les tiques. Présente surtout en Amérique du Nord, elle est de plus en plus observée en Europe, y compris dans nos régions. Elle se présente comme un syndrome grippal, avec neutro-, lympho- et thrombopénie, chez un patient mordu par une tique une ou deux semaines auparavant. Le trai...