Melioidosis, phnom penh, Cambodia.

We describe 58 adult patients with melioidosis in Cambodia (2007-2010). Diabetes was the main risk factor (59%); 67% of infections occurred during the rainy season. Bloodstream infection was present in 67% of patients, which represents 12% of all bloodstream infections. The case-fatality rate was 52% and associated with inappropriate empiric treatment

Bloodstream infection among adults in Phnom Penh, Cambodia: key pathogens and resistance patterns.

BACKGROUND: Bloodstream infections (BSI) cause important morbidity and mortality worldwide. In Cambodia, no surveillance data on BSI are available so far. METHODS: From 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. RESULTS: A 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. CONCLUSIONS: BSI 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

Pathogen distribution in 445 blood culture isolates, SHCH 2007–2010.

1<p>HA: hospital acquired isolates;</p>2<p>isolates used for calculation of resistance rate;</p>3<p>includes E. faecium (n = 3), E. fecalis (n = 2), E. raffinossus (n = 1);</p>4<p>includes A. hydrophilia group (n = 8), A. species (n = 1), A.sobria (n = 1);</p>5<p>includes A. baumanii/haemolyticus (n = 17), A. lwoffi (n = 3);</p>6<p>includes P. aeruginosa (n = 2), P. stutzeri (n = 5), P. fluorescens/putida (n = 1).</p

Antibiotic resistance patterns of <i>Enterobacteriaceae</i> from blood, SHCH 2007–2010.

*<p>by double disk testing.</p><p>SMX-TMP: sulphamethoxazole-trimethoprim; ESBL: extended spectrum β-lactamase.</p

Antibiotic resistance patterns of 46 <i>S. aureus</i> from blood, SHCH 2007–2010.

*<p>including inducible clindamycin resistance.</p><p>SMX-TMP: sulphamethoxazole-trimethoprim; MRSA: methicillin resistant Staphylococcus aureus; MSSA: methicillin susceptible Staphylococcus aureus.</p

Demographic and clinical characteristics of patients with SIRS and BSI (SHCH, 2007–2010).

<p>SIRS: systemic inflammatory response syndrome; BSI: blood stream infection; HIV: human immune deficiency virus; SSTI: skin and soft tissue infections.</p>*<p>includes chronic lung or renal disease, chronic use of steroids.</p>**<p>refers to duration of hospitalisation at moment of blood culture sampling.</p>***<p>in some patients more than one presumed focus was noted.</p

Antibiotic resistance patterns of non-fermentative Gram-negative rods from blood, SHCH 2007–2010.

<p>SMX-TMP: sulphamethoxazole-trimethoprim;</p

Flow chart of patients with SIRS episodes and corresponding episodes of bloodstream infection.

<p>SIRS was defined as the presence of more than one of the following clinical findings: body temperature of >38°C or <36°Celsius, heart rate >90 beats per minute, respiratory rate >20 per minute, PaCO₂<32 mmHg, whit e blood cell count >12000 cells/µL or <4000 cells/µL <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0059775#pone.0059775-Levy1" target="_blank">[4]</a>.</p