Staphylococcus aureus Bacteremia Incidence and Methicillin Resistance in Rural Thailand, 2006–2014

Abstract

is a common cause of bloodstream infection and methicillin-resistant (MRSA) is a growing threat worldwide. We evaluated the incidence rate of bacteremia (SAB) and MRSA from population-based surveillance in all hospitals from two Thai provinces. Infections were classified as community-onset (CO) when blood cultures were obtained ≤ 2 days after hospital admission and as hospital-onset (HO) thereafter. The incidence rate of HO-SAB could only be calculated for 2009-2014 when hospitalization denominator data were available. Among 147,524 blood cultures, 919 SAB cases were identified. Community-onset bacteremia incidence rate doubled from 4.4 (95% confidence interval [CI]: 3.3-5.8) in 2006 to 9.3 per 100,000 persons per year (95% CI: 7.6-11.2) in 2014. The highest CO-SAB incidence rate was among adults aged 50 years and older. Children less than 5 years old had the next highest incidence rate, with most cases occurring among neonates. During 2009-2014, there were 89 HO-SAB cases at a rate of 0.13 per 1,000 hospitalizations per year (95% CI: 0.10-0.16). Overall, MRSA prevalence among SAB cases was 10% (90/911) and constituted 7% (55/736) of CO-SAB and 20% (22/111) of HO-SAB without a clear temporal trend in incidence rate. In conclusion, CO-SAB incidence rate has increased, whereas MRSA incidence rate remained stable. The increasing CO-SAB incidence rate, especially the burden on older adults and neonates, underscores the importance of strong SAB surveillance to identify and respond to changes in bacteremia trends and antimicrobial resistance.

Trends in Bacteremia Over 2 Decades in the Top End of the Northern Territory of Australia

“…At its peak, in 2009, the incidence of S. aureus bacteremia in our population of 154 episodes per 100 000 person-years was among the highest reported in the Western World, likely attributable to a combination of very high rates of superficial skin diseases such as staphylococcal and streptococcal pyoderma, often complicating severe scabies infestations, socioeconomic conditions facilitating easy community transmission, and very high rates of renal replacement therapy necessitating vascular access devices or frequent percutaneous puncture, particularly among Aboriginal Australians [ 8 ]. The subsequent marked reduction in the incidence of S. aureus bacteremia since 2009 ( Figures 3 and 4 ) has been seen in other settings [ 14 , 15 ] though this trend is not universal [ 16 , 17 ]. The annual incidence of S. aureus bacteremia in the industrialized world is now typically between 10 and 50 episodes per 100 000 person-years [ 1 , 17–19 ].…”

High Burden of Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella pneumoniae Bacteremia in Older Adults: A Seven-Year Study in Two Rural Thai Provinces

“…This study used the same well-established surveillance database that was previously used to estimate the incidence and susceptibility profiles of several other pathogens in rural Thailand. 16–19…”

Inhibition of Bacterial Efflux Pumps by Crude Extracts and Essential Oil from Myristica fragrans Houtt. (Nutmeg) Seeds against Methicillin-Resistant Staphylococcus aureus

“…Further, the multidrug resistance (MDR) of the MRSA strain to β-lactam and aminoglycoside antibiotics has led to serious problems with the treatment of their related infections, and this problem is increasing worldwide [ 13 , 15 ]. MRSA strains are associated with increased mortality in several common bloodstream infections, and their burden on diseases is poorly understood in many countries [ 16 ]. In Thailand, the presence of MRSA was documented in more than 20% of S. aureus strains between 2005 and 2006 [ 16 ].…”

“…MRSA strains are associated with increased mortality in several common bloodstream infections, and their burden on diseases is poorly understood in many countries [ 16 ]. In Thailand, the presence of MRSA was documented in more than 20% of S. aureus strains between 2005 and 2006 [ 16 ]. Until now, the prevalence of MRSA infection in Thailand has been estimated to be 26%, with higher estimates (65%) among intensive care unit (ICU) patients [ 17 ].…”

“…Therefore, a better understanding of the current trends in MRSA strains is essential for their monitoring and control [ 16 ]. Further, the emergence of resistance in MRSA strain is a major threat [ 18 ].…”