Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia

Shweta R Singh; Bunsoth Mao; Konstantin Evdokimov; Pisey Tan; Phana Leab; Rick Ong; Saphonn Vonthanak; Clarence C Tam; Li Yang Hsu; Paul Turner

doi:10.1093/jacamr/dlaa097

Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia

JAC Antimicrob Resist. 2020 Dec 4;2(4):dlaa097. doi: 10.1093/jacamr/dlaa097. eCollection 2020 Dec.

Authors

Shweta R Singh¹, Bunsoth Mao², Konstantin Evdokimov¹, Pisey Tan³, Phana Leab³, Rick Ong¹, Saphonn Vonthanak², Clarence C Tam¹, Li Yang Hsu^{1

4}, Paul Turner^{3

5}

Affiliations

¹ Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
² University of Health Sciences, Phnom Penh, Cambodia.
³ Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
⁴ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁵ Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.

Abstract

Background: The rising incidence of infections caused by MDR organisms (MDROs) poses a significant public health threat. However, little has been reported regarding community MDRO carriage in low- and middle-income countries.

Methods: We conducted a cross-sectional study in Siem Reap, Cambodia comparing hospital-associated households, in which an index child (age: 2-14 years) had been hospitalized for at least 48 h in the preceding 2-4 weeks, with matched community households on the same street, in which no other child had a recent history of hospitalization. Participants were interviewed using a survey questionnaire and tested for carriage of MRSA, ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) by culture followed by antibiotic susceptibility testing. We used logistic regression analysis to analyse associations between collected variables and MDRO carriage.

Results: Forty-two pairs of households including 376 participants with 376 nasal swabs and 290 stool specimens were included in final analysis. MRSA was isolated from 26 specimens (6.9%). ESBL-producing Escherichia coli was detected in 269 specimens (92.8%) whereas ESBL-producing Klebsiella pneumoniae was isolated from 128 specimens (44.1%), of which 123 (42.4%) were co-colonized with ESBL-producing E. coli. Six (2.1%) specimens tested positive for CPE (4 E. coli and 2 K. pneumoniae). The prevalence ratios for MRSA, ESBL-producing E. coli and ESBL-producing K. pneumoniae carriage did not differ significantly in hospital-associated households and hospitalized children compared with their counterparts.

Conclusions: The high prevalence of ESBL-E across both household types suggests that MDRO reservoirs are common in the community. Ongoing genomic analyses will help to understand the epidemiology and course of MDRO spread.