Epidemiology of Bacteremia in Young Hospitalized Infants in Vientiane, Laos, 2000–2011

Anderson, M.; Luangxay, Khonesavanh; Sisouk, Kongkham; Vorlasan, Latdavan; Soumphonphakdy, Bandith; Sengmouang, Vanmaly; Chansamouth, Vilada; Phommasone, Koukeo; Dyke, Russell Van; Chong, Euming; Dance, David A. B.; Phetsouvanh, Rattanaphone; Newton, Paul N.

doi:10.1093/tropej/fmt064

Cited by 14 publications

(18 citation statements)

References 28 publications

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“…The available evidence indicates that staphylococcal infection is also of increasing concern in resource-restricted settings in Asia, including northeast Thailand 1–4,11,12. To our knowledge, our prospective multicenter study is one of the first to provide important data characterizing severe staphylococcal sepsis in such a setting.…”

Section: Discussionmentioning

confidence: 84%

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Patient Characteristics, Management, and Predictors of Outcome from Severe Community-Onset Staphylococcal Sepsis in Northeast Thailand: A Prospective Multicenter Study

West¹,

Wikraiphat²,

Tandhavanant³

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Staphylococcus aureus infection is a persistent threat in resource-restricted settings in southeast Asia but informative data about this disease remain limited. We analyzed characteristics, management, and predictors of outcome in severely septic patients with community-onset S. aureus infection in northeast Thailand. We performed a prospective, multicenter observational cohort study of community-onset S. aureus sepsis in four referral hospitals recruiting patients at least 14 years of age admitted between March 2010 and December 2013. One hundred and nineteen patients with severe staphylococcal sepsis were enrolled. Diabetes was the most common underlying condition. Methicillin-resistant infection was rare. Twenty-eight-day mortality was 20%. Ninety-two percent of patients received appropriate antibiotic therapy and 82% were administered intravenous fluids on the first hospital day, although only 14% were managed in an intensive care unit (ICU). On univariable analysis, clinical variables at enrollment significantly associated with death at 28 days were coagulopathy or respiratory failure. Plasma interleukin (IL)-8 concentration alone accurately predicted mortality (area under the receiver operating curve = 0.82, 95% confidence interval = 0.73–0.90). In multivariable analysis, addition of IL-8 concentration to a mortality prediction model containing clinical variables further improved the predictive ability of the model. We conclude that severe staphylococcal sepsis in northeast Thailand causes significant mortality. Diabetes is a common preexisting condition and most patients are managed outside the ICU even if they receive vasoactive/inotropic agents or mechanical ventilation. While clinical factors apparent on presentation including coagulopathy and respiratory failure predict death, plasma IL-8 improves this prediction.

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Section: Discussionmentioning

confidence: 84%

“…Staphylococcus aureus is an established pathogen in resource-restricted regions of southeast Asia1–4 and an increasingly important contributor to the substantial global burden of severe sepsis—the syndrome of infection accompanied by a dysregulated host inflammatory response and organ dysfunction 5,67,8.…”

Section: Introductionmentioning

confidence: 99%

Patient Characteristics, Management, and Predictors of Outcome from Severe Community-Onset Staphylococcal Sepsis in Northeast Thailand: A Prospective Multicenter Study

West¹,

Wikraiphat²,

Tandhavanant³

et al. 2017

The American Society of Tropical Medicine and Hygiene

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“…Studies reporting resistance rates are limited in Laos. One retrospective study examined resistance patterns among bacteremic isolates of hospitalized infants for a 12-year period (2000-2011) (123). Among 11 E. coli isolates observed during the study period, 33% were resistant to ceftriaxone.…”

Section: Laosmentioning

confidence: 99%

Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries

Alvarez-Uria²,

et al. 2020

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SUMMARY Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization’s Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.

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“…K. pneumoniae is among the most common cause of bloodstream infections (BSI) in South (S) and Southeast (SE) Asia [4][5][6] where it is associated with a high mortality rate [4,7]. Available data suggest a heterogenous landscape in terms of drug resistance; for example, CP strains are rare in SE Asia (< 1-4% [5,8,9]) but common in S Asia (28-70% [10,11]) and the prevalence of extendedspectrum beta-lactamase (ESBL, confers resistance to the third-generation cephalosporins) producing organisms varies from 12 to 79% in these regions [4-6, 8, 10].…”

Section: Introductionmentioning

confidence: 99%

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

et al. 2020

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Background: Klebsiella pneumoniae is a leading cause of bloodstream infection (BSI). Strains producing extendedspectrum beta-lactamases (ESBLs) or carbapenemases are considered global priority pathogens for which new treatment and prevention strategies are urgently required, due to severely limited therapeutic options. South and Southeast Asia are major hubs for antimicrobial-resistant (AMR) K. pneumoniae and also for the characteristically antimicrobial-sensitive, community-acquired "hypervirulent" strains. The emergence of hypervirulent AMR strains and lack of data on exopolysaccharide diversity pose a challenge for K. pneumoniae BSI control strategies worldwide. Methods: We conducted a retrospective genomic epidemiology study of 365 BSI K. pneumoniae from seven major healthcare facilities across South and Southeast Asia, extracting clinically relevant information (AMR, virulence, K and O antigen loci) using Kleborate, a K. pneumoniae-specific genomic typing tool. Results: K. pneumoniae BSI isolates were highly diverse, comprising 120 multi-locus sequence types (STs) and 63 Kloci. ESBL and carbapenemase gene frequencies were 47% and 17%, respectively. The aerobactin synthesis locus (iuc), associated with hypervirulence, was detected in 28% of isolates. Importantly, 7% of isolates harboured iuc plus ESBL and/or carbapenemase genes. The latter represent genotypic AMR-virulence convergence, which is generally considered a rare phenomenon but was particularly common among South Asian BSI (17%). Of greatest concern, we identified seven novel plasmids carrying both iuc and AMR genes, raising the prospect of co-transfer of these phenotypes among K. pneumoniae.Conclusions: K. pneumoniae BSI in South and Southeast Asia are caused by different STs from those predominating in other regions, and with higher frequency of acquired virulence determinants. K. pneumoniae carrying both iuc and AMR genes were also detected at higher rates than have been reported elsewhere. The study demonstrates how genomics-based surveillance-reporting full molecular profiles including STs, AMR, virulence and serotype locus information-can help standardise comparisons between sites and identify regional differences in pathogen populations.

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Epidemiology of Bacteremia in Young Hospitalized Infants in Vientiane, Laos, 2000–2011

Cited by 14 publications

References 28 publications

Patient Characteristics, Management, and Predictors of Outcome from Severe Community-Onset Staphylococcal Sepsis in Northeast Thailand: A Prospective Multicenter Study

Patient Characteristics, Management, and Predictors of Outcome from Severe Community-Onset Staphylococcal Sepsis in Northeast Thailand: A Prospective Multicenter Study

Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

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