A prospective study of bloodstream infections among febrile adolescents and adults attending Yangon General Hospital, Yangon, Myanmar

PLoS Negl Trop Dis. 2020 Apr 30;14(4):e0008268. doi: 10.1371/journal.pntd.0008268. eCollection 2020 Apr.

Abstract

Data on causes of community-onset bloodstream infection in Myanmar are scarce. We aimed to identify etiological agents of bloodstream infections and patterns of antimicrobial resistance among febrile adolescents and adults attending Yangon General Hospital (YGH), Yangon, Myanmar. We recruited patients ≥12 years old with fever ≥38°C who attended YGH from 5 October 2015 through 4 October 2016. A standardized clinical history and physical examination was performed. Provisional diagnoses and vital status at discharge was recorded. Blood was collected for culture, bloodstream isolates were identified, and antimicrobial susceptibility testing was performed. Using whole-genome sequencing, we identified antimicrobial resistance mechanisms of Enterobacteriaceae and sequence types of Enterobacteriaceae and Streptococcus agalactiae. Among 947 participants, 90 (9.5%) had bloodstream infections (BSI) of which 82 (91.1%) were of community-onset. Of 91 pathogens isolated from 90 positive blood cultures, we identified 43 (47.3%) Salmonella enterica including 33 (76.7%) serovar Typhi and 10 (23.3%) serovar Paratyphi A; 20 (22.0%) Escherichia coli; 7 (7.7%) Klebsiella pneumoniae; 6 (6.6%), Staphylococcus aureus; 4 (4.4%) yeasts; and 1 (1.1%) each of Burkholderia pseudomallei and Streptococcus agalactiae. Of 70 Enterobacteriaceae, 62 (88.6%) were fluoroquinolone-resistant. Among 27 E. coli and K. pneumoniae, 18 (66.6%) were extended-spectrum beta-lactamase (ESBL)-producers, and 1 (3.7%) each were AmpC beta-lactamase- and carbapenemase-producers. Fluoroquinolone resistance was associated predominantly with mutations in the quinolone resistance-determining region. blaCTX-M-15 expression was common among ESBL-producers. Methicillin-resistant S. aureus was not detected. Fluoroquinolone-resistant, but not multiple drug-resistant, typhoidal S. enterica was the leading cause of community-onset BSI at a tertiary hospital in Yangon, Myanmar. Fluoroquinolone and extended-spectrum cephalosporin resistance was common among other Enterobactericeae. Our findings inform empiric management of severe febrile illness in Yangon and indicate that measures to prevent and control enteric fever are warranted. We suggest ongoing monitoring and efforts to mitigate antimicrobial resistance among community-onset pathogens.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteria / classification
  • Bacteria / drug effects
  • Bacteria / isolation & purification*
  • Child
  • Community-Acquired Infections / epidemiology
  • Community-Acquired Infections / microbiology
  • Drug Resistance, Microbial*
  • Fever / etiology*
  • Hospitals, General
  • Humans
  • Middle Aged
  • Myanmar / epidemiology
  • Prospective Studies
  • Sepsis / epidemiology*
  • Sepsis / microbiology
  • Yeasts / classification
  • Yeasts / drug effects
  • Yeasts / isolation & purification*
  • Young Adult

Grants and funding

This work was supported by the New Zealand Health Research Council through an e-ASIA Joint Research Programme (grant 16/697), and an Otago Medical School Collaborative Research Grant, University of Otago, New Zealand. TOM received support through University of Otago Doctoral Scholarship. JAC also received support from Bill & Melinda Gates Foundation grant OPP1151153. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.