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Compassionate healthcare and purposeful innovation for Cambodia’s children

Antibiotic Resistance – A Global Threat Affecting Children at AHC

Antibiotic Stewardship, COMRU

Amara was unable to speak and could not support his own body weight when he first arrived at AHC’s Emergency Room, his grandmother carrying her two-year old grandson through AHC’s gates clearly distressed and worried about Amara’s health. The usually energetic boy had no previous health issues, so took him directly to the Emergency Room when he became seriously ill.

Tests confirmed that Amara had a serious Streptococcus pneumoniae infection that had developed into meningitis.

Sreng Sung, Nursing Unit Manager, AHC Pediatric Intensive Care Unit (PICU)

Streptococcus pneumoniae is a bacterial infection commonly seen in Cambodia, responsible for approximately 10% of bloodstream infections in hospitalised children and with a fatality rate of 15.6%, according to a recent study released by AHC-COMRU. Amara had developed a pneumococcal infection not vaccinated for in Cambodia. Although the pneumococcal conjugate vaccine has been part of the national immunisation schedule in Cambodia since 2015, the strain causing Amara’s infection was an unusual type not covered by the current vaccine.

Amaras’ blood culture and lumbar puncture test samples were sent to AHC’s onsite microbiology laboratory for processing to understand how the infection was reacting to the antibiotic treatment. The laboratory technicians specialise in antimicrobial resistant infections. The lab, run in collaboration with the University of Oxford’s tropical disease network, COMRU, helps diagnose and treat antimicrobial infections immediately at AHC.

The AHC Microbiology Laboratory, one of the few of its standard in Cambodia, provides up to the minute results for patients.

The results confirmed that Amara’s infection was resistant to a number of antibiotics, including ceftriaxone, which is the standard antibiotic prescribed to Streptococcus pneumoniae cases. The lab also found that his infection had spread to not only his blood, but also his cerebrospinal fluid, further complicating the severity of his condition.

Amara’s case, and his resistance to antibiotics, is not uncommon.

Antimicrobial resistance is a global threat seen every day at AHC. Many antibiotics are becoming less effective at treating illnesses, and overuse of antibiotics is speeding up this process. Without working antibiotics, routine surgeries, common infections like Streptococcus pneumoniae, and even minor injuries can become life-threatening.

“Under the guidance of the microbiologist we were able to start a new course of antibiotic treatment that showed effectiveness against Amara’s infection, which was fortunate as he was deteriorating quickly. If we continued with the regular antibiotics, he would not have survived.”

Sreng Sung, Nursing Unit Manager, AHC Pediatric Intensive Care Unit (PICU)

Amara’s condition steadily improved with the new course of antibiotic treatment showing effect on the infection. He began to speak again and show signs of normal behaviour. His health improved enough to be moved from PICU to the Inpatient Department (IPD) on day seven of his admission. While in IPD, Amara slowly began to return to his cheerful self, with his motor functions slowly returning. He still could not walk, but he began to move more freely and feel less pain.

Amara’s grandmother sat by his bedside for the entire 18-day stay at AHC

When strong enough, Amara began physiotherapy treatment with the AHC Physiotherapy nurses. They began working on simple exercises to bring movement back to his arms and legs, visiting him every day, and teaching his mother and grandmother simple exercises to perform throughout the day. The family also received regular visits by the AHC Medical Social Work team who provided emotional support for the family who had remained at his bedside for nearly a week.

It was not until two weeks after admission that Amara was finally showing no signs of infection. He could walk with support from his grandmother and was noticeably more energetic and positive. He was kept in IPD to be monitored as he finished his antibiotic treatment, while receiving supportive care from physiotherapy, social work, and IPD nurses.

Amara was discharged after 18 days at AHC, walking hand-in-hand out the hospital gates with his grandmother and mother.

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