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            <funder>The present study was part of the Surveillance and Investigation of epidemic situations in South-East Asia (SISEA) project, which was funded by the French Agency for Development (Agence Française de Développement, AFD). This surveillance project also received financial support from the US Department of Human and Health Services (US DHHS). BR received a grant from the Fondation Pierre Ledoux Jeunesse Internationale and from the Société de Pathologie Infectieuse de Langue Française</funder>
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              <keywords scheme="author">
                <term xml:lang="en">klebsiella pneumoniae</term>
                <term xml:lang="en">community-acquired</term>
                <term xml:lang="en">pneumonia</term>
                <term xml:lang="en">extended-spectrum-betalactamases</term>
                <term xml:lang="en">diabetes mellitus</term>
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              <classCode scheme="mesh">Adult</classCode>
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              <classCode scheme="mesh">Anti-Bacterial Agents</classCode>
              <classCode scheme="mesh">Blood</classCode>
              <classCode scheme="mesh">Bronchopneumonia</classCode>
              <classCode scheme="mesh">Cambodia</classCode>
              <classCode scheme="mesh">Community-Acquired Infections</classCode>
              <classCode scheme="mesh">Female</classCode>
              <classCode scheme="mesh">Humans</classCode>
              <classCode scheme="mesh">Klebsiella Infections</classCode>
              <classCode scheme="mesh">Klebsiella pneumoniae</classCode>
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              <classCode scheme="mesh">Middle Aged</classCode>
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            <abstract xml:lang="en">
              <p>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.</p>
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              <org type="consortium">Mayaud C</org>
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