Cambodia's health ministry today reported another human H5N1 avian flu case, the country's tenth of the year, according to a statement translated and posted by Avian Flu Diary, an infectious disease news blog.

The patient was a 15-year-old girl from Prey Veng province who died from her infection on August 20. An investigation found that chickens had died in the village 5 days before the girl became ill and that she had touched and held dead chickens.

Two earlier cases this summer

Cambodia reported two other H5N1 cases earlier this summer, both from Svay Rieng province. The patients—a 4-year-old boy and a 16-year-old girl—were both hospitalized for their infections and both had contact with dead poultry before they got sick.

The cases are part of an uptick in H5N1 cases in Cambodia, which has now reported 18 since early 2023. 

So far, the clade of the H5N1 virus that infected the most recent patient isn't known, but many earlier infections involved an older clade called 2.3.2.1c, which is known to circulate in poultry in some Asian countries, including Cambodia. The H5N1 clade is distinct from the 2.3.4.4b clade circulating globally, including in the United States, where the virus has also infected dairy cows, poultry, and a few farm workers.

Nearly a third of gram-negative bacterial infections in newborns with suspected sepsis in Africa are resistant to carbapenem antibiotics, researchers reported late last week in BMC Infectious Diseases.

The findings are from a review and meta-analysis conducted by researchers from Woldia University in Ethiopia who hoped to fill in knowledge gaps in the population-based epidemiology of neonatal sepsis in Africa and estimate carbapenem resistance in the gram-negative bacteria that can cause sepsis in newborns. They defined carbapenem resistance as resistance to meropenem, imipenem, or ertapenem.

Pooled prevalence of carbapenem resistance was 30%

Among the 36 studies that assessed carbapenem resistance in gram-negative bacteria isolated from newborns with suspected sepsis in Africa, there were 7,116 isolates. The most frequently isolated pathogen was Klebsiella pneumoniae, which accounted for 38.2% of all isolates. 

The pooled prevalence of carbapenem resistance in all isolates was 30.34% (95% confidence interval [CI], 22.03% to 38.64%). The pooled estimate of gram-negative bacteria resistant to imipenem, meropenem, and ertapenem was 35.57% (95% CI, 0.67% to 70.54%), 34.35% (95% CI, 20.04% to 48.67%), and 26.11% (95% CI, 15.82% to 36.40%), respectively. 

The highest prevalence of carbapenem resistance was found in Acinetobacter baumannii and Pseudomonas spp., which had pooled prevalence of 45.9% (95% CI, 33.1% to 58.7%) and 43.0% (95% CI, 23.0% to 62.4%), respectively. 

The percentage of carbapenem-resistant isolates varied widely between countries, ranging from 0.5% in Sudan to 57.9% in Egypt.

Neonatal sepsis is a primary cause of neonatal mortality in low- and middle-income countries in Africa and elsewhere. The study authors say stronger microbiology laboratory capacity to diagnose drug resistance is needed in countries with a high burden of neonatal sepsis.

To address this global health threat, it is essential to implement robust infection prevention measures, antimicrobial stewardship, and strict surveillance.

"To address this global health threat, it is essential to implement robust infection prevention measures, antimicrobial stewardship, and strict surveillance of infections and antimicrobial resistance (AMR)," the authors wrote. "This is particularly crucial as third-line medications and carbapenems are increasingly losing their effectiveness."