Staphylococcus aureus Infections in Malaysia: A Review of Antimicrobial Resistance and Characteristics of the Clinical Isolates, 1990-2017

Abstract

Staphylococcus aureus is an important nosocomial pathogen and its multidrug resistant strains, particularly methicillin-resistant S. aureus (MRSA), poses a serious threat to public health due to its limited therapeutic options. The increasing MRSA resistance towards vancomycin, which is the current drug of last resort, gives a great challenge to the treatment and management of MRSA infections. While vancomycin resistance among Malaysian MRSA isolates has yet to be documented, a case of vancomycin resistant S. aureus has been reported in our neighboring country, Indonesia. In this review, we present the antimicrobial resistance profiles of S. aureus clinical isolates in Malaysia with data obtained from the Malaysian National Surveillance on Antimicrobial Resistance (NSAR) reports as well as various peer-reviewed published records spanning a period of nearly three decades (1990-2017). We also review the clonal types and characteristics of Malaysian S. aureus isolates, where hospital-associated (HA) MRSA isolates tend to carry staphylococcal cassette chromosome mec (SCCmec) type III and were of sequence type (ST)239, whereas community-associated (CA) isolates are mostly SCCmec type IV/V and ST30. More comprehensive surveillance data that include molecular epidemiological data would enable further in-depth understanding of Malaysian S. aureus isolates.

Keywords: Antimicrobial resistance; Malaysian clinical isolates; Staphylococcus aureus; community-associated (CA); hospital-associated (HA); macrolide-lincosamide-streptogramin B (MLSB); methicillin-resistance S. aureus (MRSA); methicillin-susceptible S. aureus (MSSA); sequence types (STs); staphylococcal cassette chromosome mec (SCCmec) type.

Figure 1

The prevalence of gentamicin resistance among Malaysian S. aureus isolates, 1990–2017. Data from the National Surveillance of Antibiotic Resistance (NSAR) reports, 2003–2005 [24], 2007 [26], 2008 [25], 2009 [27], 2010 [28], 2011 [29], 2012 [30], 2013 [31], 2014 [32], 2015 [33], 2016 [4], and 2017 [5]; Hospital Kuala Lumpur (HKL) between 1990 and 1991 [13]; Various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; Hospital Universiti Sains Malaysia (HUSM) between 2002 and 2007 [15] and in 2008 [19]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; University of Malaya Medical Centre (UMMC) in 2003 and 2008 [18], and in 2013 [22]; Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2009 [20]; Hospital Raja Permaisuri Bainun (HRPB), KPJ Ipoh Specialist Hospital (KPJ) and Gribbles Pathology Ipoh (GP) between 2011 and 2012 [21]; and Hospital Sultanah Nur Zahirah (HSNZ) between 2016 and 2017 [23].

Figure 2

The prevalence of amikacin and netilmicin resistance among Malaysian MRSA isolates, 1990–2008. Data from the NSAR reports; HKL between 1990 and 1991 [13]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; and UMMC in 2003 and 2008 [18].

Figure 3

The prevalence of erythromycin resistance among Malaysian S. aureus isolates, 1990–2017. Data from the NSAR reports; HKL between 1990 and 1991 [13]; Various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; HUSM between 2002 and 2007 [15] and in 2008 [19]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; UMMC in 2003 and 2008 [18], and in 2013 [22]; UKMMC in 2009 [20]; HRPB, KPJ and GP between 2011 and 2012 [21]; and HSNZ between 2016 and 2017 [23].

Figure 4

The prevalence of clindamycin resistance in Malaysian S. aureus isolates, 2002–2017. Data from the NSAR reports; HUSM between 2002 and 2007 [15] and in 2008 [19]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; UMMC in 2003 and 2008 [18], and in 2013 [22]; UKMMC in 2009 [20]; HRPB, KPJ and GP between 2011 and 2012 [21]; and HSNZ between 2016 and 2017 [23].

Figure 5

The prevalence of tetracycline resistance among Malaysian MRSA isolates, 1997–2017. Data from the NSAR reports; Various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; UMMC in 2003 and 2008 [18]; KPJ and HRPB with an unspecified year of collection [37]; and HSNZ between 2016 and 2017 [23].

Figure 6

The prevalence of ciprofloxacin resistance among Malaysian S. aureus isolates, 1990–2017. Data from the NSAR reports; HKL between 1990 and 1991 [13]; Various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; HUSM between 2002 and 2007 [15] and in 2008 [19]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; UMMC in 2003 and 2008 [18], and 2013 [22]; UKMMC in 2009 [20]; and HSNZ in 2016 and 2017 [23].

Figure 7

Prevalence of co-trimoxazole resistance in Malaysian S. aureus isolates, 1990–2017. Data from the NSAR reports; HKL between 1990 and 1991 [13]; various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; HUSM between 2002 and 2007 [15] and in 2008 [19]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; UMMC in 2003 and 2008 [18], and in 2013 [22]; UKMMC in 2009 [20]; HRPB, KPJ and GP between 2011 and 2012 [21]; and HSNZ between 2016 and 2017 [23].

Figure 8

The prevalence of chloramphenicol resistances in Malaysian MRSA isolates, 1997–2017. Data from the NSAR reports; various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; not specified (N/S) between 2006 and 2007 [17]; HUSM in 2008 [19]; UKMMC in 2009 [20]; and HSNZ in 2016 and 2017 [23].

Figure 9

The prevalence of rifampin resistance in Malaysian S. aureus isolates, 1990–2017. Data from the NSAR reports; HKL between 1990 and 1991 [13]; various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; HUSM between 2002 and 2007 [15] and in 2008 [19]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; UMMC in 2003 and 2008 [18], and in 2013 [22]; UKMMC in 2009 [20]; HRPB, KPJ and GP between 2011 and 2012 [21]; and HSNZ between 2016 and 2017 [23].

Figure 10

The prevalence of linezolid resistance in Malaysian S. aureus isolates, 2003–2017. Data from the NSAR; UMMC in 2003 and 2008 [18]; not specified (N/S) between 2006 and 2007 [17]; HUSM in 2008 [19]; HRPB, KPJ and GP between 2011 and 2012 [21]; and HSNZ in 2016 and 2017 [23].

Figure 11

The prevalence of fusidic acid resistance in Malaysian S. aureus isolates, 1990–2017. Data from the NSAR reports; HKL between 1990 and 1991 [13]; various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; HUSM between 2002 and 2007 [15] and in 2008 [19]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; UMMC in 2003 and 2008 [18], and in 2013 [22]; UKMMC in 2009 [20]; HRPB, KPJ and GP between 2011 and 2012 [21]; and HSNZ between 2016 and 2017 [23].