Staphylococcus aureus is a major cause of community- and hospital-acquired infection in developed countries, where effective treatment is increasingly challenged by the spread of strains that are resistant to methicillin (methicillin-resistant S. aureus, MRSA). In sharp contrast to wealthy countries, S. aureus disease ranks low on the public health agenda of resource-restricted countries and is perceived as trivial in terms of morbidity and mortality compared with other infectious diseases such as malaria, tuberculosis and HIV infection. This neglected status as a developing world pathogen does not equate with low rates of disease. The spread of MRSA across low-income regions has major implications for the antimicrobial treatment of and outcome from serious S. aureus infection. In the absence of culture facilities, MRSA infection is likely to go unnoticed, and the probability of ineffective antimicrobial prescribing and poor outcome will inevitably increase. Despite its perceived importance and the large volume of research devoted to its study across the developed world, almost nothing is known about the emergence and transmission of MRSA in resource-poor regions of the world. At present, many poorer nations are not equipped to define antibiotic resistance patterns, are unable to fund expensive antibiotics required for the treatment of patients infected with MRSA, and have little or no funding for hospital infection control.
We are undertaking a programme of research in areas of resourced-restricted Asia to:
- Describe S. aureus disease in this setting
- Define the prevalence of MRSA associated with carriage and infection in hospitals and the community
- Define low-cost strategies to improve outcome from serious S. aureus infection
- Understand the benefits of low-cost interventions associated with hospital infection control