A prospective study of bloodstream infections among febrile adolescents and adults attending Yangon General Hospital, Yangon, Myanmar

Abstract

Data on causes of community-onset bloodstream infection in Myanmar are scarce. We aimed to identify etiological agents of bloodstream infections and patterns of antimicrobial resistance among febrile adolescents and adults attending Yangon General Hospital (YGH), Yangon, Myanmar. We recruited patients �12 years old with fever �38˚C who attended YGH from 5 October 2015 through 4 October 2016. A standardized clinical history and physical examination was performed. Provisional diagnoses and vital status at discharge was recorded. Blood was collected for culture, bloodstream isolates were identified, and antimicrobial susceptibility testing was performed. Using whole-genome sequencing, we identified antimicrobial resistance mechanisms of Enterobacteriaceae and sequence types of Enterobacteriaceae and Streptococcus agalactiae. Among 947 participants, 90 (9.5%) had bloodstream infections (BSI) of which 82 (91.1%) were of community-onset. Of 91 pathogens isolated from 90 positive blood cultures, we identified 43 (47.3%) Salmonella enterica including 33 (76.7%) serovar Typhi and 10 (23.3%) serovar Paratyphi A; 20 (22.0%) Escherichia coli; 7 (7.7%) Klebsiella pneumoniae; 6 (6.6%), Staphylococcus aureus; 4 (4.4%) yeasts; and 1 (1.1%) each of Burkholderia pseudomallei and Streptococcus agalactiae. Of 70 Enterobacteriaceae, 62 (88.6%) were fluoroquinolone-resistant. Among 27 E. coli and K. pneumoniae, 18 (66.6%) were extended-spectrum beta-lactamase (ESBL)-producers, and 1 (3.7%) each were AmpC beta-lactamase-and carbapenemaseproducers. Fluoroquinolone resistance was associated predominantly with mutations in the quinolone resistance-determining region. bla CTX-M-15 expression was common among ESBL-producers. Methicillin-resistant S. aureus was not detected. Fluoroquinolone-resistant, but not multiple drug-resistant, typhoidal S. enterica was the leading cause of community-onset BSI at a tertiary hospital in Yangon, Myanmar. Fluoroquinolone and extendedspectrum cephalosporin resistance was common among other Enterobactericeae. Our findings inform empiric management of severe febrile illness in Yangon and indicate that PLOS NEGLECTED TROPICAL DISEASES

High Prevalence of Methicillin-Resistant Staphylococcus aureus among Healthcare Facilities and Its Related Factors in Myanmar (2018–2019)

“…The prevalence of SA infection among biological specimens sent for culture and drug susceptibility testing in this study were five times higher than the results reported in the previous two studies from Myanmar, both of which were conducted in a single hospital and only focused on blood specimens [ 17 , 18 ]. Our study also showed a higher SA prevalence than the studies undertaken in India and Nepal [ 19 , 20 ].…”

The comparative ability of commonly used disease severity scores to predict death or a requirement for ICU care in patients hospitalised with possible sepsis in Yangon, Myanmar

“…Haematological and biochemical investigations provide additional valuable information about comorbidities and organ dysfunction, which may have a significant impact on management (Rhodes et al, 2017;Shetty et al, 2018;Singer et al, 2016). Microbiological investigations play an essential role in identifying the causative pathogen and, in an era of evolving antimicrobial resistance, recommending appropriate therapy (Dondorp et al, 2018;Myat et al, 2020;Ye Lynn et al, 2019). Meanwhile radiology assists in identifying the site of infection, facilitating the selection of empirical regimens and expediting source control (Abe et al, 2019;Williams et al, 2018).…”

“…Myanmar is one of the poorest countries in South East Asia and sepsis is the most common cause of in-hospital death (Ye Lynn et al, 2019). Although the country has made significant progress against infections like malaria (Mu et al, 2016), it remains one of the world's 30 high tuberculosis (TB) burden countries (World Health Organization, 2019;Thit, 2017), HIV affects 0.8% of adults aged 15-49 years (UNAIDS, 2018), and antimicrobial resistance is a significant and growing issue (Myat et al, 2020;Ye Lynn et al, 2019). This study was performed to determine the ability of several commonly used disease severity scores to predict the clinical course of patients with evidence of community-acquired sepsis in resource-limited tropical settings like Myanmar.…”

High burden of infections caused by ESBL-producing MDR Escherichia coli in paediatric patients, Yangon, Myanmar

“…A retrospective analysis of blood culture data from Yangon General Hospital, a tertiary hospital for adults, between 2005 to 2013 reported 37/45 E. coli isolates as resistant to ceftriaxone; however confirmatory testing for ESBLs was not performed. 8 Another study of bloodstream infections in patients in three hospitals in Yangon conducted between July and December 2014 confirmed 16/42 (38%) Gram-negative isolates were ESBL-producing Enterobacterales and 6/42 (14%) were New Delhi metallo-beta lactamase (NDM) carbapenemase producers. 9 In another tertiary hospital in the north of Yangon in 2016, almost half (49.1%) of all E. coli isolates were ESBL producers.…”