title: Bloodstream infection among adults in Phnom Penh, Cambodia: key pathogens and resistance patterns.
abstract: 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.
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. evlieghe@itg.be
authors.forename: Erika R
authors.initials: ER
authors.lastname: Vlieghe
authors.forename: Thong
authors.initials: T
authors.lastname: Phe
authors.forename: Birgit
authors.initials: B
authors.lastname: De Smet
authors.forename: Heng Chhun
authors.initials: HC
authors.lastname: Veng
authors.forename: Chun
authors.initials: C
authors.lastname: Kham
authors.forename: Kruy
authors.initials: K
authors.lastname: Lim
authors.forename: Olivier
authors.initials: O
authors.lastname: Koole
authors.forename: Lut
authors.initials: L
authors.lastname: Lynen
authors.forename: Willy E
authors.initials: WE
authors.lastname: Peetermans
authors.forename: Jan A
authors.initials: JA
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology*; D001769:Blood / Q000382:microbiology; D002160:Cambodia / Q000453:epidemiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria; D006801:Humans; D008297:Male; D008712:Methicillin / Q000627:therapeutic use; D008875:Middle Aged; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D008712:Methicillin
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