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Pediatric Bloodstream Infections in Cambodia, 2007 to 2011

Stoesser, Nicole MB BS*†‡; Moore, Catrin E. DPhil*†‡; Pocock, Joanna M. MB BChir§¶; An, Khun Peng MD*; Emary, Kate MRCP*†‡; Carter, Michael MRCPCH*‖; Sona, Soeng*; Poda, Sar*; Day, Nicholas FRCP, PhD*†; Kumar, Varun MD*; Parry, Christopher M. FRCPath, PhD*†‡

The Pediatric Infectious Disease Journal: July 2013 - Volume 32 - Issue 7 - p e272–e276
doi: 10.1097/INF.0b013e31828ba7c6
Original Studies

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.

From the *Angkor Hospital for Children, Siem Reap, Cambodia; Wellcome Trust Major Overseas Programme, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford University, Oxford; §Department of Medicine, Addenbrooke’s Hospital; University of Cambridge, Cambridge; and Institute of Child Health, University College London, London, United Kingdom.

N.S., J.M.P., C.E.M., K.E. and C.M.P. designed the study. J.M.P., K.P.A., N.S., K.E., M.J.C., V.K. and C.M.P. collected the epidemiological data. C.E.M., S.S., S.P., K.E., M.J.C., N.S., N.D. and C.M.P. developed the microbiology service at AHC; C.E.M., S.S. and S.P. undertook the microbiological analyses. V.K., N.D. and C.M.P. provided intellectual input for the data analysis; N.S. undertook the analyses. N.S. and C.M.P. drafted the article. All authors have read and approved the article.

This work was supported by the Wellcome Trust, Great Britain, United Kingdom, and the Li-Ka-Shing/University of Oxford Global Health Program. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Nicole Stoesser, MB BS, Clinical Research Fellow, Department of Microbiology, John Radcliffe Hospital Level 7, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.