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Open Access Research article

Klebsiella pneumoniae related community-acquired acute lower respiratory infections in Cambodia: Clinical characteristics and treatment

Blandine Rammaert1, Sophie Goyet1, Julien Beauté1, Sopheak Hem1, Vantha Te2, Patrich Lorn Try3, Charles Mayaud4, Laurence Borand1, Philippe Buchy1, Bertrand Guillard1 and Sirenda Vong1*

Author Affiliations

1 Institut Pasteur in Cambodia, Réseau International des Instituts Pasteur, Phnom Penh, Cambodia

2 Donkeo Provincial Hospital, Takeo, Cambodia

3 Kampong Cham Provincial hospital, Kampong Cham, Cambodia

4 Centre de pneumologie et réanimation respiratoire, Hôpital Tenon, Paris, France

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BMC Infectious Diseases 2012, 12:3  doi:10.1186/1471-2334-12-3

Published: 10 January 2012

Abstract

Background

In many Asian countries, Klebsiella pneumoniae (KP) is the second pathogen responsible for community-acquired pneumonia. Yet, very little is known about KP etiology in ALRI in Cambodia, a country that has one of the weakest medical infrastructures in the region. We present here the first clinico-radiological description of KP community-acquired ALRI in hospitalized Cambodian patients.

Methods

Through ALRI surveillance in two provincial hospitals, KP was isolated from sputum and blood cultures, and identified by API20E gallery from patients ≥ 5 years-old with fever and respiratory symptoms onset ≤14 days. Antibiotics susceptibility testing was provided systematically to clinicians when bacteria were isolated. We collected patients' clinical, radiological and microbiological data and their outcome 3 months after discharge. We also compared KP-related with other bacteria-related ALRI to determine risk factors for KP infection.

Results

From April 2007 to December 2009, 2315 ALRI patients ≥ 5 years-old were enrolled including 587 whose bacterial etiology could be assigned. Of these, 47 (8.0%) had KP infection; their median age was 55 years and 68.1% were females. Reported prior medication was high (42.5%). Patients' chest radiographs showed pneumonia (61.3% including 39% that were necrotizing), preexisting parenchyma lesions (29.5%) and pleural effusions alone (4.5%) and normal parenchyma (4.5%). Five patients had severe conditions on admission and one patient died during hospitalization. Of the 39 patients that were hospital discharged, 14 died including 12 within 1 month after discharge. Only 13 patients (28%) received an appropriate antibiotherapy. Extended-spectrum beta-lactamases (ESBL) - producing strains were found in 8 (17.0%) patients. Female gender (Odds ratio (OR) 2.1; p = 0.04) and diabetes mellitus (OR 3.1; p = 0.03) were independent risk factors for KP-related ALRI.

Conclusions

KP ALRI in Cambodia has high fatality rate, are more frequently found in women, and should be considered in diabetic patients. The extremely high frequency of ESBL-producing strains in the study is alarming in the context of uncontrolled antibiotic consumption and in absence of microbiology capacity in most public-sector hospitals.

Keywords:
Klebsiella pneumoniae; Community-acquired; Pneumonia; Extended-spectrum betalactamases; Diabetes mellitus