Abstract
Staphylococcus aureus is an important nosocomial pathogen and its multidrug resistant strains, particularly methicillin-resistant S. aureus (MRSA), poses a serious threat to public health due to its limited therapeutic options. The increasing MRSA resistance towards vancomycin, which is the current drug of last resort, gives a great challenge to the treatment and management of MRSA infections. While vancomycin resistance among Malaysian MRSA isolates has yet to be documented, a case of vancomycin resistant S. aureus has been reported in our neighboring country, Indonesia. In this review, we present the antimicrobial resistance profiles of S. aureus clinical isolates in Malaysia with data obtained from the Malaysian National Surveillance on Antimicrobial Resistance (NSAR) reports as well as various peer-reviewed published records spanning a period of nearly three decades (1990–2017). We also review the clonal types and characteristics of Malaysian S. aureus isolates, where hospital-associated (HA) MRSA isolates tend to carry staphylococcal cassette chromosome mec (SCCmec) type III and were of sequence type (ST)239, whereas community-associated (CA) isolates are mostly SCCmec type IV/V and ST30. More comprehensive surveillance data that include molecular epidemiological data would enable further in-depth understanding of Malaysian S. aureus isolates.
Highlights
Staphylococcus aureus is a frequently encountered Gram-positive nosocomial pathogen that is associated with a wide array of diseases, ranging from simple skin infection to more serious and potentially life-threatening infections such as infective endocarditis and toxic shock syndrome [1,2]
In their 2014 global report, the World Health Organization (WHO) listed methicillin-resistant S. aureus (MRSA) as one of the seven pathogens of international concern and that has been associated with a high number of mortality and septic shock cases compared to methicillin-susceptible S. aureus (MSSA) [1]
The purpose of this review is to provide a general overview of the antimicrobial resistance trends of clinical S. aureus isolates in Malaysia obtained from various published reports of individual studies as well as the Malaysian National Surveillance on Antimicrobial Resistance (NSAR) annual reports
Summary
Staphylococcus aureus is a frequently encountered Gram-positive nosocomial pathogen that is associated with a wide array of diseases, ranging from simple skin infection to more serious and potentially life-threatening infections such as infective endocarditis and toxic shock syndrome [1,2]. The MRSA strains have become endemic in most hospitals worldwide, including in Asia [3], and are a treatment challenge to physicians. In their 2014 global report, the World Health Organization (WHO) listed MRSA as one of the seven pathogens of international concern and that has been associated with a high number of mortality and septic shock cases compared to MSSA [1]. Reports regarding MRSA strains that had developed resistance to vancomycin have emerged in many parts of the world, with the first of such strains reported in the United States almost two decades ago [7]. The occurrence of such strains, known as vancomycin-resistant S. aureus (VRSA), is not as abundant as MRSA. The molecular mechanism of antibiotic resistance and other characteristics of the S. aureus isolates, such as their sequence types (STs) and other molecular epidemiological markers, are presented
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