Bacteremia Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae in Vientiane, Lao PDR: A 5-Year Study

Abstract

Although there has been an increasing incidence of bacteremia caused by extended-spectrum betalactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) across South East Asia, there are sparse data from the Lao PDR, where laboratory capacity for antimicrobial resistance surveillance is limited. We, therefore, retrospectively reviewed bacteremia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae between 2010 and 2014 at Mahosot Hospital, Vientiane, Lao PDR. Clinical and laboratory data relating to all episodes of ESBL-E bacteremia were reviewed over the 5-year period and compared with non-ESBL-E bacteremia. Blood cultures positive for E. coli or K. pneumoniae were identified retrospectively from laboratory records. Clinical and laboratory data were extracted from research databases and case notes and analyzed using STATA. Between 2010 and 2014, we identified 360 patients with E. coli (n = 249) or K. pneumoniae (n = 111) bacteremia, representing 34.8% of all patients with clinically significant bacteremia. Seventy-two (20%) isolates produced ESBL; E. coli accounted for 15.3% (55/360) and K. pneumoniae for 4.7% (17/360), respectively. The incidence of ESBL-producing E. coli bacteremia rose during the study period. By multiple logistic analysis, reported antibiotic use in the previous week was significantly associated with ESBL positivity (P < 0.001, odds ratio 3.89). Although multiresistant, most ESBL-producing E. coli and K. pneumoniae remained susceptible to meropenem (65/65; 100%) and amikacin (64/65; 98.5%). We demonstrated an alarming increase in the incidence of ESBL-E as a cause of bacteremia in Vientiane during the study period. This has implications for empiric therapy of sepsis in Laos, and ongoing surveillance is essential.

Antimicrobial use and resistance data in human and animal sectors in the Lao PDR: evidence to inform policy

“… 9 Chang et al reported the trend of ESBL-producing E. coli bacteraemia in Laos from 2010 to 2014, increasing from 7.8% (4/51) to 34.7% (17/49). 10 A larger dataset from Microbiology/LOMWRU laboratory from 2004 to 2016, which included data from Chang et al , showed that the actual proportion increased five-fold from 7% (2/28) in 2004 to 35% (27/78) in 2016 ( figure 3 ). 8 Among 280/1,837 inpatients and outpatients at Mahosot Hospital with urinary tract infection (UTI) that yielded significant growth from 2010 to 2011, 194/280 (69%) grew E. coli .…”

Automating the Generation of Antimicrobial Resistance Surveillance Reports: Proof-of-Concept Study Involving Seven Hospitals in Seven Countries

“…Angkor Hospital for Children used the ACORN LIS that is based on the Microsoft Access program [ 36 ]. Mahosot Hospital used a local LIS that is also based on the Microsoft Access program [ 37 ]. Sunpasitthiprasong Hospital used the MLAB program [ 38 ].…”

Automating the generation of antimicrobial resistance surveillance reports: a proof-of-concept study in seven hospitals in seven countries

“…Angkor Hospital for Children used ACORN LIS which was based on Microsoft Access program [35]. Mahosot Hospital used a local LIS which was also based on Microsoft Access program [36]. Sunpasitthiprasong Hospital used MLAB programme [37].…”