title: Etiologies and resistance profiles of bacterial community-acquired pneumonia in Cambodian and neighboring countries' health care settings: a systematic review (1995 to 2012).
abstract: OBJECTIVE
  Community-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.
  
  
  METHODS
  A 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Google scholar, EMBASE, the World Health Organization and the Cambodian Ministry of Health libraries; (2) a review of unpublished data from Cambodia provided by national and international stakeholders working at different tiers of the healthcare system.
  
  
  RESULTS
  Twenty 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.
  
  
  CONCLUSIONS
  Based 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.
authors.affiliation: Epidemiology unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Sophie
authors.initials: S
authors.lastname: Goyet
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Erika
authors.initials: E
authors.lastname: Vlieghe
authors.affiliation: Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Varun
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Naval Medical Research Unit2, Phnom Penh, Cambodia.
authors.forename: Steven
authors.initials: S
authors.lastname: Newell
authors.affiliation: Angkor Hospital for Children, Siem Reap, Cambodia; Wellcome Trust Major Overseas Programme, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford University, Oxford, United Kingdom.
authors.forename: Catrin E
authors.initials: CE
authors.lastname: Moore
authors.affiliation: Angkor Hospital for Children, Siem Reap, Cambodia; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford University, Oxford, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bousfield
authors.affiliation: National Institute of Public Health, Phnom Penh, Cambodia.
authors.forename: Heng C
authors.initials: HC
authors.lastname: Leang
authors.affiliation: National Institute of Public Health, Phnom Penh, Cambodia.
authors.forename: Sokheng
authors.initials: S
authors.lastname: Chuop
authors.affiliation: Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
authors.forename: Phe
authors.initials: P
authors.lastname: Thong
authors.affiliation: Hopital Necker-Enfants malades service des Maladies Infectieuses et Tropicales, APHP, Paris, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Rammaert
authors.affiliation: Epidemiology unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Sopheak
authors.initials: S
authors.lastname: Hem
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium; Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
authors.forename: Johan
authors.initials: J
authors.lastname: van Griensven
authors.affiliation: Naval Medical Research Unit2, Phnom Penh, Cambodia.
authors.forename: Agus
authors.initials: A
authors.lastname: Rachmat
authors.affiliation: University of Health Sciences, Faculty of Medicine, Phnom Penh, Cambodia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fassier
authors.affiliation: Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
authors.forename: Kruy
authors.initials: K
authors.lastname: Lim
authors.affiliation: Epidemiology unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Tarantola
mesh_terms: D016957:Burkholderia pseudomallei; D002160:Cambodia / Q000453:epidemiology; D016993:Chlamydophila pneumoniae; D017714:Community-Acquired Infections / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D006193:Haemophilus influenzae; D006801:Humans; D007711:Klebsiella pneumoniae; D009177:Mycoplasma pneumoniae; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D013296:Streptococcus pneumoniae