Bloodstream Infection among Adults in Phnom Penh, Cambodia: Key Pathogens and Resistance Patterns

Abstract

BackgroundBloodstream infections (BSI) cause important morbidity and mortality worldwide. In Cambodia, no surveillance data on BSI are available so far.MethodsFrom all adults presenting with SIRS at Sihanouk Hospital Centre of HOPE (July 2007–December 2010), 20 ml blood was cultured. Isolates were identified using standard microbiological techniques; antibiotic susceptibilities were assessed using disk diffusion and MicroScan®, with additional E-test, D-test and double disk test where applicable, according to CLSI guidelines.ResultsA total of 5714 samples from 4833 adult patients yielded 501 clinically significant organisms (8.8%) of which 445 available for further analysis. The patients’ median age was 45 years (range 15–99 y), 52.7% were women. HIV-infection and diabetes were present in 15.6% and 8.8% of patients respectively. The overall mortality was 22.5%. Key pathogens included Escherichia coli (n = 132; 29.7%), Salmonella spp. (n = 64; 14.4%), Burkholderia pseudomallei (n = 56; 12.6%) and Staphylococcus aureus (n = 53; 11.9%). Methicillin resistance was seen in 10/46 (21.7%) S. aureus; 4 of them were co-resistant to erythromycin, clindamycin, moxifloxacin and sulphamethoxazole-trimethoprim (SMX-TMP). We noted combined resistance to amoxicillin, SMX-TMP and ciprofloxacin in 81 E. coli isolates (62.3%); 62 isolates (47.7%) were confirmed as producers of extended spectrum beta-lactamase. Salmonella isolates displayed high rates of multidrug resistance (71.2%) with high rates of decreased ciprofloxacin susceptibility (90.0%) in Salmonella Typhi while carbapenem resistance was observed in 5.0% of 20 Acinetobacter sp. isolates.ConclusionsBSI in Cambodian adults is mainly caused by difficult-to-treat pathogens. These data urge for microbiological capacity building, nationwide surveillance and solid interventions to contain antibiotic resistance.

Antimicrobial susceptibility of uropathogens isolated from Cambodian children

“…In a study conducted in the capital, Phnom Penh, resistance to fosfomycin was observed in adults. 13 The resistance to mecillinam, not seen in other studies, suggests that this antibiotic should be used with caution in our setting. [14][15][16] For children with urosepsis, gentamicin, ESC and ciprofloxacin would not be reliable empirical choices.…”

Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia

“…In Cambodia, the only published data are from a nongovernmental organization's hospital in Phnom Penh, where only 1 of 17 (5.9%) AB isolates cultured from blood between 2007 and 2010 was resistant to carbapenems (159).…”

Increase in Salmonella enterica serovar Paratyphi A infections in Phnom Penh, Cambodia, January 2011 to August 2013

“…Over the past two decades, S. Paratyphi A has become increasingly prevalent in Asia, causing between 15% (Pakistan, Indonesia) and 64% (southeast China) of enteric fever cases in these countries [4]. Typhoid and paratyphoid fever are also endemic in Cambodia [5][6][7]. Nationwide surveillance of incidence and antibiotic resistance patterns is, however, largely lacking due to the country's very limited microbiology laboratory infrastructure [8].…”