Mrsa In Thailand

[swlondonmum]

Does anyone have any info about MRSA in Thailand? It is discussed a lot in the Uk but a quick google and search of this forum found very little and nothing recent. Antibiotics are taken a lot here - I'm not medical expert so can't say that's wrong especially as this is a tropical country but they are much more readily available and taken more frequently. Friends and family don't seem to know much about things like the fact that they don't cure viruses, or you should always complete a course of them, any what the dangers of overuse/not completing the course are (ie resistance of bacteria to antibiotics, MRSA etc).

I would imagine that most countries in the world have MRSA to a similar extent but thought it was strange that I can't find any info about it here - is it more or less common here than other countries, what is done about prevention/treatment in hospitals here, do rates vary in different areas/different hospitals/state/private, is it getting more common here or just any other info!

[jrtmedic]

MRSA is a world-wide problem. There seem to be only a few studies of the problem which relate to Thailand specifically. You can find one here - http://www.ncbi.nlm....pubmed/20509037

In the West antibiotics are usually prescription only medications and the WHO, Governments, and the health care professions have all promoted the establishment and maintenance of national and international surveillance programmes. Surveillance has been coupled with increased and on going education of professionals and the general public in relation to the appropriate use of antibiotics. Other measures such as increasing awareness of techniques associated with limiting/preventing the spread of antibiotic resistant organisms within hospitals and the wider community have been implimented. Pre - operative screening of people undergoing elective surgery is well established and is designed to identify and treat innocent "carriers" before they can become a risk to themselves or others.

In the developing world the situation is very different. Antibiotics are on open sale and abused by the general public and the medical profession. This state of affairs is likely to result in a major problem, not only for developing countries but the world at large. There is already evidence of virulent strains of antibiotic resistant organisms originating in developing countries appearing in the West.

The problem is not just associated with methicillin-resistant staphylococcus aureus ( MRSA) but is also associated with other organisms ie. those which cause TB or gastro-enteritis.

There are no easy solutions but one of the first and most important steps is to ensure the control and appropriate use of antibiotics.

Edited December 29, 2012 by jrtmedic

[CaptHaddock]

Although overuse of antibiotics may play some role in hospital-based infections the largest cause is that doctors and other health care workers do not wash their hands often enough or well enough, according to surgeon/writer Atul Gawande:

http://www.counterpunch.org/2007/03/24/on-washing-hands/

[jrtmedic]

In Europe, only Romania and Malta had higher rates of MRSA than the United States in 2004. MRSA levels were high in East Asia, specifically South Korea, Japan, and Taiwan, probably because of high levels of antibiotic use, but not much higher than for the United States. In the Americas, only Argentina, Brazil, and Colombia had a higher MRSA prevalence than the United States.

The USA indeed did have a major problem! I believe they now have some control on the situation.

However, hand washing is just one measure which is proven to reduce cross infection (transfer of organisms from one person to another)

Poor hand hygiene as practised by some health care personnel is NOT the cause of antibiotic resistant organisms emerging, although such poor practise does aid the dissemination of infection.

Misuse of antibiotics IS the root cause of of the widespread problem of antibiotic resistant organisms.

Edited December 29, 2012 by jrtmedic

[swlondonmum]

Thanks both of you for the replies.

Jrtmedic - thanks for the info - I don't know how the UK compares but I guess it's good that at least there is a lot of awareness about it. Because of the need for a prescription, as you say it is harder to get antibiotics without good reason. Like many people I've been to the doc (in UK) if I've bad a particularly bad cough etc and have generally been told it's most likely a virus and will get better by itself. Docs are understandably more cautious with kids (or the elderly/sick) because of the speed with which they can deteriorate - when my son was a baby they did give antibiotics a few times as a precaution when they weren't sure.

Since we've been in Thailand (9 months) my (Thai) husband and son have had several courses of antibiotics, the most recent for a stomach bug - this from a pharmacy who said it was most likely bacterial as it had lasted more than 24 hrs....Even a very well educated and international Thai friend brought a big stash of antibiotics to the uk so they were easy to take if she got sick with a cold or upset stomach!

And yes you are right that misuse of antibiotics causes other problems as well as MRSA - it was just MRSA that started off my curiosity but it's interesting to know about the others too and I'm sure I will check out some more online.

I think you are both right about the causes - antibiotic overuse/misuse for creating the resistance and poor hygiene for the spread of it. I have noticed things that I would not expect to see in the uk. I had laser eye surgery here and the nurses put eye drops (not disposable one, a normal bottle which would be used again) in my eyes A without washing their hands first and B I'm pretty sure they touched my eyelashes/the corner or my eyes, both of which I imagine can spread infection. When we have had vaccinations the nurse has not worn disposable gloves or washed their hands immediately before, and has touched the cotton wool for cleaning the skin (and squeezed it out, therefore touching the part which will touch the skin).

My son got an abscess following a vaccination - we have no proof that it was caused by the hospital but the doctor who treated it basically said this type of abscess is extremely rare - it only happens 4-5times a year and would never happen if nurses practiced good hygiene (ie washing hands or wearing gloves, using tongs to pick up cotton wool). When we told him the vaccine had been done at THE SAME HOSPITAL which he didn't realise, his tune changed and when we went for the follow up he completely contradicted himself and said the above points about hygiene would not cause and abscess (and of course the lab results didn't develop so couldn't show either way!). He drained the abscess (at our cost) but it has still not cleared up and it was while looking this up online that I came across info about MRSA which made me wonder how prevalent it was here.

Sorry to go off topic a bit above but from the hospitals and clinics I have visited in Thailand (private and government) I get the impression that the doctors seem pretty much similar to the west in their opinions/knowledge but it is the nurses/clinic staff/pharmacy staff who don't seem to be following the guidelines regarding use of antibiotics or hygiene. I don't know if it is because they are not trained properly or just don't think it's important. the doc who treated my sons abscess said he had told nurses lots of times to carry out his hygiene recommendations but they didn't think it was important as most of the time things ended up fine even when they didn't follow the rules - they probably just think the 4-5 people a year who got abscesses were unlucky!

Well I have done my bit by educating my husband about antibiotics - will try and spread to his family and friends too!

Edited December 29, 2012 by swlondonmum

[jeepguy]

Generally a big issue with MRSA is, once you have it, you will always have it and become a carrier. If you are unsure, have the patient's nose hairs swabbed and it will probably be positive. Obviously, when it the active phase ie. wound drainage it will be contagious. It can be very dangerous/deadly, an employee died in a U.S. prison about 4 years ago (age 42) after going septic, spreading to the lungs etc. Watch out for sharing towels, gyms etc. Infectious disease M.D. told me that less outbreaks were seen using "Dial anti-bacterial soap".

[jrtmedic]

MRSA is not an infectious disease in the traditional sense. MRSA poses no risk to young fit people or even old fit people!

It is certainly true that due to the widespread abuse of antibiotics that there are individuals, in the community, who are "carriers" but speaking generally these people pose no risk to themselves or to others.

People who are discoverd to be "carriers " of MRSA are easily treated. with various skin disinfectants and nasal oinments-- it is not a life long affiliction !

People who are at risk from MRSA are usually very young or very old and very sick. The organism gains entry to the individuals blood stream via legitimate medical interventions such as providing Intravenous fluids. Once in the blood stream the organism causes a septicaemia which is very difficult to treat as there are only a very few, reserved , antibiotics which are effectve and some of these are toxic and have to be used with great care,

Of far greater importance than MRSA is, for example, antibiotic resistent gonorrhea (common in Asia) and antibiotic resistent TB , which again is common in Asia but is already found in the West.

Edited December 31, 2012 by jrtmedic