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CAUSES OF COMMUNITY-ACQUIRED BACTEREMIA AND PATTERNS OF ANTIMICROBIAL RESISTANCE IN VIENTIANE, LAOS

There is no published information on the causes of bacteremia in the Lao PDR (Laos). Between 2000 and 2004, 4512 blood culture pairs were taken from patients admitted to Mahosot Hospital, Vientiane, Laos, with suspected community-acquired bacteremia; 483 (10.7%) cultures grew a clinically significant community-acquired organism, most commonly Salmonella enterica serovar typhi (50.9%), Staphylococcus aureus (19.0%), and Escherichia coli (12.4%). S. aureus bacteremia was common among infants (69.2%), while children 1–5 years had a high frequency of typhoid (44%). Multi–drug-resistant S. Typhi was rare (6%). On multiple logistic regression analysis, typhoid was associated with younger age, longer illness, diarrhea, higher admission temperature, and lower peripheral white blood cell count than non-typhoidal bacteremia. Empirical parenteral ampicillin and gentamicin would have some activity against ~ 88% of clinically significant isolates at a cost of US $1.4/day, an important exception being B. pseudomallei. Bacteremic infants in this setting require an anti-staphylococcal antibiotic.

Acknowledgments: We are very grateful to all the patients who participated in this study, the hospital staff, especially Ammala Xayyavong, Viengmone Davong, Olay Lattana, Manivanh Vongsouvath, Anisone Changthongthip, Viengmala Siharath, Oday Phimmasone, Soulignasack Thongpaseuth, Sengmani Symanivong, Kaiamporn Keopaseuth, and Aratsany Chandara. We are very grateful for the help and advice of Christopher Parry, Kasia Stepniewska, Jay Berkley, Miriam Laufer, Chirapha Darasavath, Oudayvone Rattanavong, Siho Sisouphone, Ko Chang, Vannaporn Wuthiekanun, Andrew Simpson, Jenny Short, Nicholas Day, and the physicians of Health Frontiers. Syseng Khounsy and the Department of Livestock and Fisheries kindly provided goat blood. SP is supported by a Wellcome Trust Career Development Award in clinical tropical medicine. We are very grateful to the Minister of Health, His Excellency Dr Ponmek Dalaloy, and the Director of the Curative Department, Ministry of Health, Professor Sommone Phounsavath for their support for this study, which was part of the Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration.

Financial support: This work was supported by the Wellcome Trust of Great Britain.

^* Address correspondence to Paul N. Newton, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR. Telephone and fax: (856) 21 242168. E-mail: paul{at}tropmedres.ac

Authors’ addresses: Rattanaphone Phetsouvanh, Simmaly Phongmany, Douangdao Soukaloun, Bouachanh Rasachak, Vimone Soukhaseum, Seun Soukhaseum, Kamthavi Frichithavong, Sengmanivong Khounnorath, Bounthom Pengdee, Khamphong Phiasakha, Vang Chu, Khonesavanh Luangxay, Sayadeth Rattanavong, Konkam Sisouk, Mayboun Heuanvongsy, Bounthaphany Bounxouei, Chanpheng Thammavong, and Bounkong Syhavong, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and fax: (856) 21 242168; Valy Keolouangkot, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and fax: (856) 21 242168 and Francophone Institute of Tropical Medicine, Vientiane, Lao PDR; Mayfong Mayxay, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and fax: (856) 21 242168 and Department of Post Graduates and Research, Faculty of Medical Science, National University of Laos, Lao PDR. Andrew Ramsay, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and fax: (856) 21 242168 and Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, United Kingdom and Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand; Stuart D. Blacksell, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and fax: (856) 21 242168 and Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, United Kingdom and Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand; Jim Campbell, Oxford University Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam, Telephone: (848) 9237954, fax: (848) 9238904; Bertrand Martinez-Aussel, Francophone Institute of Tropical Medicine, Vientiane, Lao PDR, Telephone: (856) 20 5622571; Michel Strobel, Francophone Institute of Tropical Medicine, Vientiane, Lao PDR, Telephone: (856) 20 7704934; Sharon J. Peacock, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, United Kingdom and Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand, Telephone: (66) 2 354 1396; Nicholas J. White, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and fax: (856) 21 242168 and Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, United Kingdom and Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand, Telephone: (66) 2 354 1396; Paul N. Newton, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR, Telephone and fax: (856) 21 242168 and Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, United Kingdom.

Reprint requests: Paul N. Newton, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR, Telephone and fax: (856) 21 242168, E-mail: paul{at}tropmedres.ac.