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
Source: PubMed

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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Available from: Eoin West, Jan 16, 2014
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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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    ABSTRACT: 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. faecalis), by surveillance, and to evaluate antibacterial potencies of 30 plants with information on ethnomedicinal uses for infectious ailments by the aborigine Kandha tribe of Kalahandi district, Odisha (India), against both pathogens.Methods Over a period of 6 months bacteria/ strains of S. aureus and E. faecalis were isolated from clinical samples in a teaching hospital and their antibiograms were ascertained using 17 antibiotics of 9 different groups. S. aureus strains were further tested for confirmation if they were methicillin and vancomycin resistant, similarly, E. faecalis strains for vancomycin resistance. Concentrated aqueous and ethanolic extracts of leaves/barks of 30 plants were used for monitoring their antimicrobial potencies, by the agar-well diffusion method, along with qualitative phytochemical analyses.ResultsFrom the surveillance, both pathogens were found MDR and it was evident that the distribution of MDR strains was more in hospital-acquired than community-acquired samples. Both aqueous and ethanolic extracts of plants, Diospyrous melanoxylon, Woodfordia fruticosa (W. fruticosa), Oroxylum indicum (O. indicum), Dalbergia paniculata and Lantana camara had the most significant in vitro controlling capacity against MDR strains of both bacteria. Further, extracts of Holarrhena antidysenterica, Aspidopterys tomentosa and Argyreia speciosa had moderate antibacterial activities. Ethanolic extracts of L. camara, O. indicum and W. fruticosa contained all the phytochemicals, alkaloids, glycosides, terpenoids, reducing sugars, saponins, tannins, flavonoids and steroids, which could be attributed to the recorded significant antibacterial activity.ConclusionS. aureus strains have been found as the most widely prevailing pathogens in nosocomial settings, than in community. Plants, L. camara. W. fruticosa, O. indicum and P. santalinus, particularly could be useful for a use as complementary/ supplementary/alternative therapeutic agents against Gram-positive pathogens.
    08/2012; 2(4):273–281. DOI:10.1016/S2222-1808(12)60060-7
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    ABSTRACT: Antimicrobial resistance has increased drastically in recent years in the developing countries, and it has rapidly become a leading public health concern. The prevalence of antimicrobial resistance varies greatly between and within countries and between different pathogens. However, overall a trend to the increase of the resistance to those antimicrobial agents more often used in these countries has been observed. Several factors can contribute to the rapid emergence and dissemination of antimicrobial resistance. In this paper, the current antimicrobial resistance in different microorganisms from different countries as well as the factors contributing to the emergence and spread of resistance in developing countries will be reviewed.
    The Open Infectious Diseases Journal 09/2010; 4(2). DOI:10.2174/1874279301004020038
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