Increasing Resistance to Trimethoprim-Sulfamethoxazole Among Isolates of Escherichia coli in Developing Countries

Abstract

Resistance of Escherichia coli to trimethoprim (TMP)-sulfamethoxazole remains at 3%-8% at many medical centers within the United States. In this study a 44% resistance rate was observed among E. coli isolated at a pediatric hospital in Santiago, Chile, and a 40% resistance rate at a general teaching hospital in Bangkok, Thailand. Most isolates were from urinary tract infections and showed high-level resistance (minimal inhibitory concentration of TMP greater than 1,000 micrograms/ml). Nineteen of 35 isolates tested transferred resistance to TMP; most cotransferred resistance to streptomycin and sulfonamides. Dihydrofolate reductase type I was detected by gene probing in 14 of 35 strains. Subsequent investigations in Brazil, Honduras, and Costa Rica revealed that this high rate of resistance was not an isolated phenomenon.

Occurrence of multiple antibiotic resistance and R plasmids in Enterobacteriaceae isolated from children in the Sudan

“…Young et al (1986) found 58 different plasmid types associated with trimethoprim resistance in isolates from south India. Murray et al (1985) found plasmid sizes ranging from 42 to 80 MDa associated with trimethoprim resistance in Chilean isolates. In our study, plasmids of molecular weight 62 MDa occurred most frequently, and were associated with different resistance patterns.…”

“…Considerable attention has been paid to the indiscriminate use of antibiotics (Murray et al 1985;Koh, 1986;Burke & Levy, 1985). This is particularly the case in the management of diarrhoeal diseases despite W.H.O.…”

“…Extensive and inappropriate use of antimicrobials in the treatment of childhood gastroenteritis is common in many developing countries (Tomson & Sterky, 1986;Chetley, 1987), and numerous studies have suggested this may result in the development of resistance in commensal gut bacteria Murray et al 1985), and in enteric pathogens (Shahid et al 1985). There are only limited data available for much of African on either the prevalence or genetic basis of antibiotic resistance, and the need for effective surveillance studies has been emphasized (O'Brien, 1986).…”

Transferable high-level trimethoprim resistance among isolates ofEscherichia colifrom urinary tract infections in Ontario, Canada

“…Trimethoprim (TMP) either alone or in combination with sulfamethoxazole (cotrimoxazole) is commonly used as standard therapy for urinary tract infections, and increased resistance to both agents have been reported to occur in isolates of Escherichia coli in different parts of the world [1][2][3][4]. The introduction of newer alternative antimicrobial agents have also resulted in rapidly developing resistance which threatens the usefulness of these agents [5].…”

Trimethoprim resistant dihydrofolate reductases in normal faecal flora isolated in India

“…In developing countries, however, resistance is a growing problem, with high levels being reported in Africa, South America and Asia amongst enterobacteria [5][6][7], including Salmonella spp. [8,9] and Shigella spp. [10][11][12].…”