title: Bloodstream infections at a tertiary referral hospital in Yangon, Myanmar.
abstract: BACKGROUND
  Data regarding characteristics of bloodstream infections in Myanmar are limited.
  
  
  METHODS
  Blood culture results from all outpatients and inpatients were extracted from records of the Clinical Microbiology Laboratory, Yangon General Hospital, for the period 2005 through 2013.
  
  
  RESULTS
  Of 3865 blood cultures performed, 449 (11.6%) were positive for a pathogenic organism. Gram-negative bacteria was the most common organism group, accounting for 246 (55.5%) of 449 isolations. Staphylococcus aureus was the most common isolate, detected in 171 (38.1%) of 449 blood cultures. From 2005-2008 to 2009-2013 the proportion of all pathogenic isolates that were Gram-positive declined from 52.8% (167/316) to 20.3% (27/133) (p<0.001), whereas the proportion of Gram-negative bacteria rose from 45.6% (144/316) to 78.9% (105/133) (p<0.001), with non-fermentative bacilli accounting for much of this increase. Antimicrobial susceptibility testing demonstrated a high prevalence resistance of S. aureus to first-line antimicrobials such as erythromycin, penicillin and oxacillin. More than half of tested Escherichia coli and Citrobacter species showed resistance to amoxicillin-clavulanic acid, ceftriaxone or gentamicin.
  
  
  CONCLUSIONS
  Bloodstream infections are common among patients receiving blood culture at a tertiary hospital in Yangon, Myanmar. Our findings suggest that antimicrobial resistance among invasive bacteria is common, similar to patterns described elsewhere in the region, and highlight the need for locally adapted antimicrobial guidelines for sepsis management.
authors.affiliation: Department of Microbiology, University of Medicine 1, Yangon, Myanmar.
authors.forename: Tin Ohn
authors.initials: TO
authors.lastname: Myat
authors.affiliation: Centre for International Health, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand.
authors.forename: Namrata
authors.initials: N
authors.lastname: Prasad
authors.affiliation: Department of Microbiology, University of Medicine 1, Yangon, Myanmar.
authors.forename: Kyi Kyi
authors.initials: KK
authors.lastname: Thinn
authors.affiliation: Department of Microbiology, University of Medicine 1, Yangon, Myanmar.
authors.forename: Kyu Kyu
authors.initials: KK
authors.lastname: Win
authors.affiliation: Department of Microbiology, University of Medicine 1, Yangon, Myanmar.
authors.forename: Wah Win
authors.initials: WW
authors.lastname: Htike
authors.affiliation: Clinical Laboratory Department, Yangon General Hospital, Yangon, Myanmar.
authors.forename: Khwar Nyo
authors.initials: KN
authors.lastname: Zin
authors.affiliation: Department of Pathology, University of Otago Christchurch, 2 Riccarton Avenue, P.O. Box 4345, Christchurch 8011, New Zealand.
authors.forename: David R
authors.initials: DR
authors.lastname: Murdoch
authors.affiliation: Centre for International Health, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand john.crump@otago.ac.nz.
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D002954:Citrobacter / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D002052:Myanmar / Q000453:epidemiology; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Antimicrobial drug resistance; Bacteremia; Fever; Myanmar