International AIDS Conference location:Toronto, Canada date:2006
Information about bacteria responsible for invasive infections in PHA in resource-poor countries and about antibiotic susceptibility are scarce.
We installed aerobic bacterial blood cultures with manual identification in Sihanouk Hospital Center of HOPE, Cambodia. We entered culture results and specific patient information from the request in an Access database. We performed a retrospective analysis of anonymous data: we evaluated only blood cultures from registered HIV-positives.
Between 22-2-2005 and 15-1-2006 180 blood cultures were received from patients registered as PHA. Only 19% were suspected to have a resistant bacterial infection based on failure of recent antibiotic treatment. In most a disseminated infection was suspected, with the most frequent suspected foci respiratory and gastro-intestinal. 79% had temperature 38.5°C in the last week. 40% had cough and 20% had diarrhea. 48% received antifungals and 45% cotrimoxazole, mainly as prophylaxis for cryptococcosis and PCP. 13% had received beta-lactams and 11% quinolones in the previous two weeks.
28 blood cultures (16%) were positive: 9 yielded Salmonella species (3 typhi), 7 Staphylococcus aureus, 3 Enterobacteriaceae, 2 Mycobacteria, 2 Morganella, 1 Staphylococcus epidermidis (contamination?), 1 Pseudomonas aeruginosa, 1 Klebsiella, 1 Acinetobacter, 1 Corynebacterium (contamination).
We found resistance to methicilline in 4 (57%) Staphylococcus aureus, resistance to ofloxacin in 4 (44%) and to gentamicin in 4 Salmonellae, (all sensitive to ceftriaxone), resistance to ofloxacin in 3 (38%), to gentamicin in 2 (25%) and to ceftriaxone in 2 (25%) of the other Gram-negatives.
Antibiotic resistance becomes a major constraint in treating bacterial opportunistic infections in Cambodian PHA. About halve of isolates from blood cultures are resistant to antibiotics recommended by guidelines . Identification of resistant germs and antibiotics to treat them should be available. Further emergence of antibiotic resistance should be limited by restricting and optimizing the use of antibiotics.