Monday, April 13, 2009

Action needed on S. aureus in developing SE Asian countries

Medical Tribune March 2009 P12
David Brill

The burden of Staphylococcus aureus in low-income south and east Asian countries is poorly understood and could pose a threat to the health of both developed and developing countries, an international team of researchers has warned.

The lack of data on drug resistance rates in particular could exacerbate the problem if a strategic research program is not defined, the group wrote in a recent review in The Lancet Infectious Diseases. [2009 Feb;9(2):130-135]

The regional prevalence of methicillin-resistant S. aureus (MRSA), for example, remains largely unknown, although surveillance data from India and China suggest that the strain represents a substantial and rising proportion of the overall S. aureus burden. This knowledge gap could be contributing to the lack of recognition given to the problem by healthcare workers and the public, the study authors say.

The unregulated sale of cheap, substandard over-the-counter antibiotics could also be fuelling the emergence of MRSA in these countries, they add.

Mortality data on S. aureus in developing Asian countries are also scarce, but one study from a Thai hospital found that the death rate from bacteremia could be as high as 48 percent. [Lancet Infect Dis 2006 Feb;6(2):70-1] A comparable study in the US reported a mortality of just 22 percent. [Arch Intern Med 2003 Sep 22;163(17):2066-72]

Children seem particularly vulnerable to S. aureus in low-income countries in south and east Asia, unlike in high-income countries where the incidence of the bug appears largely to increase with age. The same study from Thailand found that S. aureus infections were most common in neonates, who made up 25 percent of all cases, while another study from Laos demonstrated that S. aureus was the number one cause of bacteremia in children aged under 1 year. [Am J Trop Med Hyg 2006 Nov;75(5):978-85]

“The burden of S. aureus disease in developing regions is inadequately appreciated or understood. An initiative is needed to raise the profile of S. aureus disease in developing countries, and to fund studies to better define the healthcare challenges and potential practical solutions relating to this important global pathogen,” wrote the authors, who hail from the Mahidol University in Bangkok, Thailand, the University of Oxford, UK, and the University of Washington in Seattle, US.

A total of 96 papers were included in the literature review – comprising published data from 20 low-income or lower-middle income countries including Indonesia, the Philippines, Vietnam and Cambodia.

Besides establishing the prevalence of MRSA, future research should also be directed at identifying risk factors for S. aureus and implementing cheap but effective mechanisms for infection control, the authors wrote.

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