Abstract
BackgroundMost information on invasive Staphylococcus aureus infections comes from temperate countries. There are considerable knowledge gaps in epidemiology, treatment, drug resistance and outcome of invasive S. aureus infection in the tropics.MethodsA prospective, observational study of S. aureus bacteraemia was conducted in a 1000-bed regional hospital in northeast Thailand over 1 year. Detailed clinical data were collected and final outcomes determined at 12 weeks, and correlated with antimicrobial susceptibility profiles of infecting isolates.Principal FindingsNinety-eight patients with S. aureus bacteraemia were recruited. The range of clinical manifestations was similar to that reported from temperate countries. The prevalence of endocarditis was 14%. The disease burden was highest at both extremes of age, whilst mortality increased with age. The all-cause mortality rate was 52%, with a mortality attributable to S. aureus of 44%. Methicillin-resistant S. aureus (MRSA) was responsible for 28% of infections, all of which were healthcare-associated. Mortality rates for MRSA and methicillin-susceptible S. aureus (MSSA) were 67% (18/27) and 46% (33/71), respectively (p = 0.11). MRSA isolates were multidrug resistant. Only vancomycin or fusidic acid would be suitable as empirical treatment options for suspected MRSA infection.Conclusions S. aureus is a significant pathogen in northeast Thailand, with comparable clinical manifestations and a similar endocarditis prevalence but higher mortality than industrialised countries. S. aureus bacteraemia is frequently associated with exposure to healthcare settings with MRSA causing a considerable burden of disease. Further studies are required to define setting-specific strategies to reduce mortality from S. aureus bacteraemia, prevent MRSA transmission, and to define the burden of S. aureus disease and emergence of drug resistance throughout the developing world.
Highlights
S. aureus is a significant pathogen in northeast Thailand, with comparable clinical manifestations and a similar endocarditis prevalence but higher mortality than industrialised countries
S. aureus bacteraemia is frequently associated with exposure to healthcare settings with methicillin-resistant S. aureus (MRSA) causing a considerable burden of disease
The published literature on invasive Staphylococcus aureus disease is heavily skewed towards industrialised temperate countries, where it represents a major cause of community- and hospitalacquired infection [1,2]
Summary
The published literature on invasive Staphylococcus aureus disease is heavily skewed towards industrialised temperate countries, where it represents a major cause of community- and hospitalacquired infection [1,2]. Attributable mortality rates for S. aureus bacteraemia (SAB) in the developed world are typically up to 30% [5,6,7], and the costs of treating nosocomial infection, screening for MRSA carriage and changes in prescribing practices to include cover for MRSA are considerable. This situation has attracted huge public and media attention and receives significant research funding. There are considerable knowledge gaps in epidemiology, treatment, drug resistance and outcome of invasive S. aureus infection in the tropics
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