Staphylococcus aureus bacteraemia in a tropical setting: Patient outcome and impact of antibiotic resistance
Abstract
Background: Most 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. Methods:
A 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 Findings: Ninety-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. © 2009 Nickerson et al.
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https://hdl.handle.net/10161/4512Published Version (Please cite this version)
10.1371/journal.pone.0004308Publication Info
Nickerson, Emma K; Hongsuwan, Maliwan; Limmathurotsakul, Direk; Wuthiekanun, Vanaporn;
Shah, Krupal R; Srisomang, Pramot; ... Peacock, Sharon J (2009). Staphylococcus aureus bacteraemia in a tropical setting: Patient outcome and impact
of antibiotic resistance. PLoS ONE, 4(1). pp. e4308. 10.1371/journal.pone.0004308. Retrieved from https://hdl.handle.net/10161/4512.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Vance Garrison Fowler Jr.
Florence McAlister Distinguished Professor of Medicine
Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia Antibacterial
ResistancePathogenesis of Bacterial Infections Tropical medicine/International Health

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