title: Pediatric bloodstream infections in Cambodia, 2007 to 2011.
abstract: BACKGROUND
  Pediatric bacterial bloodstream infections (BSIs) are a major cause of morbidity and mortality worldwide. Epidemiological data from resource-limited settings in southeast Asia, such as Cambodia, are sparse but have important implications for treatment and public health strategies.
  
  
  METHODS
  We retrospectively investigated BSI in children at a pediatric hospital and its satellite clinic in Siem Reap, Cambodia, from January 1, 2007, to July 31, 2011. The range of bacterial pathogens and their antimicrobial susceptibility patterns were analyzed in conjunction with demographic, clinical and outcome data.
  
  
  RESULTS
  Of 7682 blood cultures with results (99.9% of cultures taken), 606 (7.9%) episodes of BSI were identified in 588 children. The incidence of BSI increased from 14 to 50/1000 admissions (P < 0.001); this was associated with an increased sampling rate. Most BSI were community acquired (89.1%). Common pathogens included Salmonella Typhi (22.8% of all isolates), Staphylococcus aureus (12.2%), Streptococcus pneumoniae (10.0%), Klebsiella pneumoniae (6.4%) and Escherichia coli (6.3%). 21.5% of BSI were caused by a diverse group of uncommon organisms, the majority of which were environmental Gram-negative species. No Listeria monocytogenes or Group B streptococcal BSI were identified. Antimicrobial resistance, particularly among the Enterobacteriaceae, was common. Overall mortality was substantial (19.0%), higher in neonates (36.9%) and independently associated with meningitis/meningoencephalitis and K. pneumoniae infection.
  
  
  CONCLUSIONS
  BSI is a common problem in Cambodian children attending hospital and associated with significant mortality. Further studies are needed to clarify the epidemiology of neonatal sepsis, the contribution of atypical organisms and the epidemiology of pneumococcal disease before the introduction of vaccine.
authors.affiliation: Angkor Hospital for Children, Siem Reap, Cambodia. nicole.stoesser@ndm.ox.ac.uk
authors.forename: Nicole
authors.initials: N
authors.lastname: Stoesser
authors.forename: Catrin E
authors.initials: CE
authors.lastname: Moore
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Pocock
authors.forename: Khun Peng
authors.initials: KP
authors.lastname: An
authors.forename: Kate
authors.initials: K
authors.lastname: Emary
authors.forename: Michael
authors.initials: M
authors.lastname: Carter
authors.forename: Soeng
authors.initials: S
authors.lastname: Sona
authors.forename: Sar
authors.initials: S
authors.lastname: Poda
authors.forename: Nicholas
authors.initials: N
authors.lastname: Day
authors.forename: Varun
authors.initials: V
authors.lastname: Kumar
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D001419:Bacteria / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification*; D001769:Blood / Q000382:microbiology*; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents