Etiologies and Resistance Profiles of Bacterial Community-Acquired Pneumonia in Cambodian and Neighboring Countries’ Health Care Settings: A Systematic Review (1995 to 2012)

Abstract

ObjectivesCommunity-acquired pneumonia (CAP) is one of the most important causes of morbidity and mortality worldwide. Etiological data for Cambodia is scarce. We aimed to describe the main etiological agents causing CAP, and their resistance patterns in Cambodia and the greater Mekong region.MethodsA review of bacterial etiologies of CAP and antimicrobial resistance in Cambodia and neighboring countries was conducted via: (1) a systematic review of published literature in all NCBI databases using Pubmed, Google scholar, EMBASE, the World Health Organization and the Cambodian Ministry of Health libraries; (2) a review of unpublished data from Cambodia provided by national and international stakeholders working at different tiers of the healthcare system.ResultsTwenty three articles and five data sources reported etiologies for 5919 CAP patients diagnosed between May 1995 and December 2012, including 1421 (24.0%), 3571 (60.3%) and 927 (15.7%) from Cambodia, Thailand and Vietnam, respectively. Streptococcus pneumoniae and Haemophilus influenzae were the most common pathogens ranking among the five most prevalent in 12 and 10 studies, respectively. Gram-negative bacteria such as Burkholderia pseudomallei and Klebsiella pneumoniae were also frequently diagnosed, particularly in bacteremic CAP in Thai adults and Cambodian children. In Thailand and Vietnam, Mycoplasma pneumoniae and Chlamydia pneumoniae were frequently identified in settings using indirect laboratory testing.ConclusionsBased on this analysis, CAP data in Cambodia seems to present etiological and resistance profiles comparable to those of neighboring countries. Findings have been shared with the national authorities upon the revision of the national therapeutic guidelines and were disseminated using a specially created website.

Pneumonia in the tropics

“…38 This has changed the way local clinicians initiate their empiric treatment for patients admitted for severe CAP, with antibiotics deliberately chosen to cover Gram-negative organisms, melioidosis as well as Gram-positive pathogens. A systematic review by Goyet et al 39 looking at resistance patterns of CAP pathogens in Cambodia and neighbouring countries showed that up to 14% of S. pneumoniae and 26.5% of K. pneumoniae were resistant to amoxicillin-clavulanic acid. Streptococcus pneumoniae also displayed a high resistance to trimethoprim/sulfamethoxazole (average of 78.2%) and wide range of resistance patterns to cephalosporins: between 5.7% and 33.3% to ceftriaxone, and up to 47.4% to cefuroxime.…”

“…As a result of this study, the authors have advocated the preservation of fluoroquinolones as they are not warranted as first-line therapy, and they are also used to treat TB, which importantly is endemic in this region. 39 This highlights the importance of continued surveillance of regional resistance patterns and revision of therapeutic guidelines.…”

Management of bacterial severe sepsis and septic shock

“…In the developing world, S. pneumoniae and H. influenzae, including type B, S. aureus, and enteric Gram negatives are causes of pneumonia [152][153][154]. In Africa, non-typhoidal Salmonella is an additional common etiology of bacteremic pneumonia, especially among human immunodeficiency virus infected children [155,156].…”

Bacterial Profile and Their Antibiotic Resistance Pattern Among HIV Patients Diagnosed with Pneumonia in Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

“…Antimicrobial resistance in bacteria that cause infectious diseases is a global problem, even if it varies from region to region depending upon the antibiotic pressure in that locality [11]. Bacteria isolated from HIV patients with pneumonia shows varying degree of antimicrobial resistance to common antimicrobials [12]. Since bacterial pneumonia in HIV patients is the common pulmonary complication.…”