Effect of Trimethoprim-Sulfamethoxazole Prophylaxis on Faecal Carriage Rates of Resistant Isolates of Escherichia Coli in Hiv-Infected Adult Patients in Lagos.

Abstract

Background: The daily use of Trimethoprim-Sulfamethoxazole (TMP-SMX) prophylaxis reduces morbidity and mortality among patients infected with Human Immunodeficiency Virus (HIV) but its impact on increasing antimicrobial resistance rates has been of public concern globally. This study investigated the effect of daily TMP-SMX prophylaxis on faecal carriage rates of resistant isolates of Escherichia coli in HIV-infected adult patients in Lagos. Methods: A total of 550 HIV-infected patients with CD4-cell count of less than 350 cell/mm 3 and were eligible for TMP-SMX prophylaxis attending Lagos University Teaching Hospital, Lagos, Nigeria, were recruited. Stool/rectal swab samples were aseptically collected from the patients and processed using standard methods for culture and sensitivity. Results: There was a baseline Trimethoprim-Sulfamethoxazole resistance rate of 54% which increased to 77.9% in first 3 months, rising to 96.1% by 6 months and all isolates were resistant by the 9th month. There was also evidence of crossresistance to other antibiotics with significant association with TMP-SMX resistance (p<0.0001). The Escherichia coli isolates showed a progressive increase in resistance to the tested antibiotics over the 12-month period. The resistance was in the following order: Ampicillin (74% to 82.6% in the first 3 months; 98.3% by the 6th month and 99.4% by the 9th month; all isolates were resistant by the 12th month). Augmentin (32.5% to 47.7% in first 3 months; 76.1% by the 6th month; 86.3% by the 9th month; all isolates were resistant by 12 months). Ceftriaxone (2.0% to 10.8% in first 3 months; 20.6% by the 6th month; 24.2% by the 9th month; 54.3% by the 12 months). Conclusion:The carriage rate of faecal E. coli resistant to TMP-SMX is common before TMP-SMX prophylaxis. Initiation of TMP-SMX leads to further increase in resistance to TMP-SMX and cross-resistance to other antimicrobials.

Does cotrimoxazole prophylaxis in HIV patients increase the drug resistance of pneumococci? A comparative cross-sectional study in southern Ethiopia

“…and Neisseria spp. [6,16,17]. However, in contrast to this, a couple of studies reported that CTX prophylaxis does not affect the emergence of resistance and colonization rates, helping to protect from common bacterial pathogens [7,15].…”

High prevalence of multidrug-resistant bacteria in fomites in a tertiary institution in Southwestern Nigeria

“…TEM enzymes are capable of hydrolyzing penicillin, older cephalosporins, and oxyimino-cephalosporins, such as cefotaxime and ceftazidime with relative ease. Other investigators have also detected this gene in Enterobacteriaceae and other Gram-negative bacteria in different settings globally [47,48]. The detection of TEM gene could undermine the treatment of infections caused by thirdgeneration cephalosporin-resistant isolates.…”

Gut resistome linked to sexual preference and HIV infection

“…People living with HIV (PLWH) are more probably colonized and/or infected by MDRO [4][5][6][7][8]. This population has increased rates of comorbidities, more frequent hospital admissions and receive more antibiotic treatment courses and prophylaxis compared to the general population [9,10]. Additionally, HIV infection is associated with immunosuppression and changes in gut microbiome composition, all predisposing factors for MDRO acquisition [11,12].…”