title: High Prevalence of Antimicrobial-resistant Gram-negative Colonization in Hospitalized Cambodian Infants.
abstract: BACKGROUND
  Antimicrobial-resistant Gram-negative infections are a significant cause of mortality in young infants. We aimed to determine characteristics of, and risk factors for, colonization and invasive infection caused by 3rd generation cephalosporin (3GC) or carbapenem-resistant organisms in outborn infants admitted to a neonatal unit (NU) in Cambodia.
  
  
  METHODS
  During the first year of operation, patients admitted to the Angkor Hospital for Children NU, Siem Reap, Cambodia, underwent rectal swabbing on admission and twice weekly until discharge. Swabs were taken also from 7 environmental sites. Swabs were cultured to identify 3GC or carbapenem-resistant Acinetobacter sp., Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.
  
  
  RESULTS
  The study included 333 infants with a median age at NU admission of 10 days (range, 0-43). Colonization by ≥1 3GC-resistant organism was detected in 85.9% (286/333). Admission swabs were collected in 289 infants: 61.9% were colonized by a 3GC-resistant organism at the time of admission, and a further 23.2% were colonized during hospitalization, at a median of 4 days [95% confidence interval: 3-5]. Probiotic treatment (hazard ratio: 0.58; 95% confidence interval: 0.35-0.98) was associated with delayed colonization. Colonization by a carbapenem-resistant organism occurred in 25 (7.5%) infants. Six infants had NU-associated K. pneumoniae bacteremia; phenotypically identical colonizing strains were found in 3 infants. Environmental colonization occurred early.
  
  
  CONCLUSIONS
  Colonization by antimicrobial-resistant Gram-negative organisms occurred early in hospitalized Cambodian infants and was associated with subsequent invasive infection. Trials of potential interventions such as probiotics are needed.
authors.affiliation: From the *Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia; †Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; ‡Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; and §Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Paul
authors.initials: P
authors.lastname: Turner
authors.forename: Sreymom
authors.initials: S
authors.lastname: Pol
authors.forename: Sona
authors.initials: S
authors.lastname: Soeng
authors.forename: Poda
authors.initials: P
authors.lastname: Sar
authors.forename: Leakhena
authors.initials: L
authors.lastname: Neou
authors.forename: Phal
authors.initials: P
authors.lastname: Chea
authors.forename: Nicholas Pj
authors.initials: NP
authors.lastname: Day
authors.forename: Ben S
authors.initials: BS
authors.lastname: Cooper
authors.forename: Claudia
authors.initials: C
authors.lastname: Turner
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002160:Cambodia / Q000453:epidemiology; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents