Article

Staphylococcus aureus disease and drug resistance in resource-limited countries in south and east Asia

Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
The Lancet Infectious Diseases (Impact Factor: 19.45). 03/2009; 9(2):130-5. DOI: 10.1016/S1473-3099(09)70022-2
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ABSTRACT By contrast with high-income countries, Staphylococcus aureus disease ranks low on the public-health agenda in low-income countries. We undertook a literature review of S aureus disease in resource-limited countries in south and east Asia, and found that its neglected status as a developing world pathogen does not equate with low rates of disease. The incidence of the disease seems to be highest in neonates, its range of clinical manifestations is as broad as that seen in other settings, and the mortality rate associated with serious S aureus infection, such as bacteraemia, is as high as 50%. The prevalence of meticillin-resistant S aureus (MRSA) infection across much of resource-limited Asia is largely unknown. Antibiotic drugs are readily and widely available from pharmacists in most parts of Asia, where ease of purchase and frequent self-medication are likely to be major drivers in the emergence of drug resistance. In our global culture, the epidemiology of important drug-resistant pathogens in resource-limited countries is inextricably linked with the health of both developing and developed communities. An initiative is needed to raise the profile of S aureus disease in developing countries, and to define a programme of research to find practical solutions to the health-care challenges posed by this important global pathogen.

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    • "Antimicrobial resistance in resourcepoor settings is fueled by weak control of antibiotic prescribing and stewardship both in the community and hospitals, and by weak infection control infrastructure that fails to prevent the transmission of nosocomial pathogens—many of which are multidrug resistant. Methicillin-resistant Staphylococcus aureus (MRSA) is a leading nosocomial pathogen worldwide (Nickerson et al. 2009a, b; Falagas et al. 2013). MRSA carriage in the community remains low in many countries, and healthcare-associated infection is often associated with acquisition within a healthcare setting. "
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    ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial infection. Whole-genome sequencing of MRSA has been used to define phylogeny and transmission in well-resourced healthcare settings, yet the greatest burden of nosocomial infection occurs in resource-restricted settings where barriers to transmission are lower. Here, we study the flux and genetic diversity of MRSA on ward and individual patient levels in a hospital where transmission was common. We repeatedly screened all patients on two intensive care units for MRSA carriage over a 3-mo period. All MRSA belonged to multilocus sequence type 239 (ST 239). We defined the population structure and charted the spread of MRSA by sequencing 79 isolates from 46 patients and five members of staff, including the first MRSA-positive screen isolates and up to two repeat isolates where available. Phylogenetic analysis identified a flux of distinct ST 239 clades over time in each intensive care unit. In total, five main clades were identified, which varied in the carriage of plasmids encoding antiseptic and antimicrobial resistance determinants. Sequence data confirmed intra- and interwards transmission events and identified individual patients who were colonized by more than one clade. One patient on each unit was the source of numerous transmission events, and deep sampling of one of these cases demonstrated colonization with a "cloud" of related MRSA variants. The application of whole-genome sequencing and analysis provides novel insights into the transmission of MRSA in under-resourced healthcare settings and has relevance to wider global health. © 2015 Tong et al.; Published by Cold Spring Harbor Laboratory Press.
    Genome Research 12/2014; 25(1). DOI:10.1101/gr.174730.114 · 13.85 Impact Factor
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    • "Indeed, the problem from its infection have been multiplied by the development of resistance to beta-lactams and a large number of antibiotics of other groups, aminoglycosides, glycopeptides, fluoroquinolones, sulfonamides, etc. By the by, MDR 'methicillin resistant S. aureus' (MRSA) has been considered as the superbug in the health domain, today [4] . The most common ailments caused Objective: To record hospital-and community-acquired accounts of multidrug resistance (MDR) of two Gram-positive pathogens, Staphylococcus aureus (S. aureus) and Enterococcus faecalis (E. "
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    08/2012; 2(4):273–281. DOI:10.1016/S2222-1808(12)60060-7
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    The Open Infectious Diseases Journal 09/2010; 4(2). DOI:10.2174/1874279301004020038
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