Emergence of Trimethoprim‐Sulfamethoxazole Resistance in the AIDS Era

Abstract

Trimethoprim-sulfamethoxazole (TMP-SMX) is widely used for Pneumocystis carinii pneumonia prophylaxis in human immunodeficiency virus (HIV)-infected patients, but little is known about the effects of this practice on the emergence of TMP-SMX-resistant bacteria. A serial cross-sectional study of resistance to TMP-SMX among all clinical isolates of Staphylococcus aureus and 7 genera of Enterobacteriaceae was performed at San Francisco General Hospital. Resistance among all isolates was <5.5% from 1979 to 1986 but then markedly increased, reaching 20.4% in 1995. This was most prominent in HIV-infected patients: resistance increased from 6.3% in 1988 to 53% in 1995. The largest increases in resistance were in Escherichia coli (24% in 1988 to 74% in 1995) and S. aureus (0% to 48%) obtained from HIV-infected patients. A rapid increase in the use of prophylactic TMP-SMX in HIV disease was also observed during this time in San Francisco and is likely responsible for the increase in TMP-SMX resistance.

Time for new recommendations on cotrimoxazole prophylaxis for HIV-exposed infants in developing countries

“…7 One of the major risks of cotrimoxazole prophylaxis will be the potential for promoting cotrimoxazole resistance among common pathogens circulating in the community, as well as acquisition of infections caused by resistant organisms in the individual receiving prophylaxis. Several studies have shown an increase in resistance of pathogens to cotrimoxazole following widespread use of prophylaxis.…”

Épidémie de sida en Afrique subsaharienne

“…Pour la prophylaxie par le cotrimoxazole, les recommandations internationales font l'objet d'un débat centré sur deux questions: la prévalence du paludisme et le spectre de sensibilité au cotrimoxazole des bactéries en cause dans la morbidité associée au VIH n'étant pas les mêmes partout, les résultats concluants des essais réalisés en Côte-d'Ivoire sont-ils transposables dans d'autres pays africains [50]? Existe-t-il un risque qu'une large utilisation du cotrimoxazole puisse précipiter l'émergence de résistances au cotrimoxazole lui-même, mais aussi à d'autres agents antiinfectieux de première ligne, non seulement chez les personnes prenant du cotrimoxazole, mais aussi dans la population géné-rale [51,52]? Un suivi clinique à long terme des cohortes de personnes recevant cette prophylaxie est donc nécessaire pour continuer à décrire la morbidité sous cotrimoxazole, cette description in vivo étant la seule susceptible de répondre à la question de savoir si le cotrimoxazole continue à avoir un bénéfice sur un site donné, quel que soit le contexte de résis-tances in vitro [53].…”

Epidemiology and clinical relevanceofPneumocystis jiroveciiFrenkel, 1976 dihydropteroate synthase gene mutations

“…Another sulfone agent, dapsone, is an important second-line prophylactic drug against P. jirovecii (Kaplan et al, 2002). Since sulpha resistance has developed in an increased number of common bacteria isolated in HIV-infected and non-HIV-infected patients, coinciding with the rise in TMP-SMZ prophylaxis for PcP (Martin et al, 1999), it looked plausible that P. jirovecii could become resistant to sulpha and sulphone agents. Because this organism cannot be cultivated in vitro determination of resistance by traditional methods is not possible.…”