title: 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.
  
  
  RESULTS
  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.
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Nickerson
authors.forename: Maliwan
authors.initials: M
authors.lastname: Hongsuwan
authors.forename: Direk
authors.initials: D
authors.lastname: Limmathurotsakul
authors.forename: Vanaporn
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: Krupal R
authors.initials: KR
authors.lastname: Shah
authors.forename: Pramot
authors.initials: P
authors.lastname: Srisomang
authors.forename: Weera
authors.initials: W
authors.lastname: Mahavanakul
authors.forename: Therapon
authors.initials: T
authors.lastname: Wacharaprechasgul
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: T Eoin
authors.initials: TE
authors.lastname: West
authors.forename: Nitaya
authors.initials: N
authors.lastname: Teerawatanasuk
authors.forename: Harald
authors.initials: H
authors.lastname: Becher
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Wirongrong
authors.initials: W
authors.lastname: Chierakul
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Day
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004352:Drug Resistance, Microbial; D004696:Endocarditis / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013211:Staphylococcus aureus / Q000187:drug effects; D013785:Thailand / Q000453:epidemiology; D014329:Tropical Climate; D055815:Young Adult