Staphylococcus Aureus Bacteraemia in the Lao People’s Democratic Republic: Antibiotic Susceptibility Patterns and Clinical Management / Lao Medical Journal

ABSTRACT

Staphylococcus aureus is a common and often serious human pathogen accounting for about a fifth of all cases of bacteraemia with an associated mortality of up to 50%. This review summarizes the aspects of S. aureus bacteraemia that are relevant in a Lao context, including the antibiotic susceptibility patterns seen at Mahosot Hospital, Vientiane over the past 11 years and provides guidance and rationale for clinical management. In the Lao PDR it is the third commonest cause of bacteraemia and the leading cause of skin and soft-tissue infection. Mahosot Hospital has seen almost 200 cases and antibiotic susceptibility testing shows that a significant proportion of isolates are tetracycline and erythromycin resistant. Methicillin-resistance remains very rare, though this is unlikely to continue. Key risk factors for S. aureus disease in financially-poor settings include surgical procedures and previous antibiotic exposure. The identification and removal or drainage of a focus of infection is a key part of the management strategy. Transthoracic echocardiography (TTE) is advised for all patients, where this technique is accessible, and consideration should be given to repeating this test or performing a transoesophageal echocardiogram for patients with a negative TTE, but with a high index of suspicion for infective endocarditis. Treatment with a !-lactam antibiotic (preferably cloxacillin), for 2 weeks in uncomplicated disease and 4 to 6 weeks in complicated disease, is essential to provide cure and prevent relapse. An oral switch may be required, though this should take place only if the patient has been afebrile for 48 hours and has no ongoing complications requiring intervention. Copyright ∀ 2012 Elliot et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.