Longitudinal survey of ATB resistance reversibility in children with AIDS of genocide survivors in Cambodia

Background: The aim of the survey was to assess antimicrobial resistance dynamics and reversibility in the group of children with AIDS in Cambodia in 2003 2015. Patients: Correlation between antimicrobial (ATB) resistances in commonest respiratory isolates among 140 children with AIDS on antiretroviral therapy was studied from 2003 to 2015 in 586 isolates. Original Articles 8 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 7 No. 3 2016 Results: All but 3 (98%) children showed a sustained CD4 increase after introduction of antiretroviral therapy (ART) followed by a decrease of ATB resistance. In our group of children restoration of the immune system decreased the number of infection diseases episodes and the proportion of multi-resistant bacterial strains. Conclusions: Less frequent use of antimicrobial therapy probably led to the decrease of multi-resistance and restoration of susceptibility of studied respiratory bacterial isolates. Results and discussion Table 1 presents trends in ATB resistance in major respiratory isolates from October 2003 to December 2015 (total of 586 isolates). Penicillin resistance in pneumococci decreased from 25% to 2% in 2015 (P<0.01); t-test for trends), MRSA from 33.3% in 2003 to 3% in 2014 and 2% in 2015 (P<0.01). Erythromycin resistance in Streptococcus pyogenes decreased from 10.5% in 2003 to 3.3% in 2015. At baseline extremely high proportion of ESBL producing Enterobacteriaceae decreased from 66.6% to 25% and such trend was also observed in Candida species and resistance to fluconazole (from 15% in 2003 to 6% in 2015). Reversibility of ATB resistance was documented on the hospital level (2) or on the community national level (1.3), however only in countries with small population (Finland, Denmark, Iceland) with centralized ATB policy. Reversibility time was 2-5 years per country and more (up to 5 years). Reversibility of susceptibility or antibiotic resistance was not yet sufficiently studied in pediatric population with specific immunodeficiency therefore it is deficient to assess, of 10 15 years in our group is comparable to e.g. 2 5 years on a nation level from Europe (5-8).