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.
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An increased number of sulfa-resistant bacteria have been isolated in HIV patients, coinciding with the rise in TMP-SMX prophylaxis for PCP.
“Indeed, an increased number of sulfa-resistant bacteria have been isolated in HIV patients, which coincides with the rise in TMP-SMX prophylaxis for PCP (6,7).”
From Dihydropteroate Synthase Gene Mutations in<i>Pneumocystis</i>and Sulfa Resistance (2004) · cites this paper as [6]
The rise in resistant organisms was significantly more prominent in samples obtained from HIV-infected patients, in whom resistant isolates increased from 6.3% in 1988 to 53% in 1995.
“In addition, the rise in resistant organisms was significantly more prominent in samples obtained from HIV-infected patients, in whom resistant isolates increased from 6.3% in 1988 to 53% in 1995.”
From Dihydropteroate Synthase Gene Mutations in<i>Pneumocystis</i>and Sulfa Resistance (2004) · cites this paper as [6]
In one study, the prevalence of TMP-SMX-resistant Staphylococcus aureus and Enterobacteriaceae species isolated in all hospitalized patients increased significantly from <5.5% of isolates before 1986 to 20% in 1995.
“In one study, the prevalence of TMP-SMX–resistant Staphylococcus aureus and Enterobacteriaceae species isolated in all hospitalized patients increased significantly from <5.5% of isolates before 1986 to 20% in 1995, during which time TMP-SMX prophylaxis was increasing in HIV-infected patients (6).”
From Dihydropteroate Synthase Gene Mutations in<i>Pneumocystis</i>and Sulfa Resistance (2004) · cites this paper as [6]
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“Indeed, an increased number of sulfa-resistant bacteria have been isolated in HIV patients, which coincides with the rise in TMP-SMX prophylaxis for PCP (6,7).”
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HUANG, L., MORRIS, A. M., & BEARD, C. B. (2001) · Journal of Eukaryotic Microbiology · doi:10.1111/j.1550-7408.2001.tb00510.x · Cited by 10 · see citing works
- Authors
- Martin, J. N., Rose, D. A., Hadley, W. K., Perdreau‐Remington, F., Lam, P. K., & Gerberding, J. L.
- Affiliations
- San Francisco General Hospital (US)
- University of California System (US)
- Corresponding author
- Martin, Jeffrey N.
- ORCID
- Martin, Jeffrey N.
- Venue
- The Journal of Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 1999-12
- Volume
- 180
- Issue
- 6
- Pages
- 1809-1818
- ISSN
- 0022-1899 (ISSN-L)
- 1537-6613
- OpenAlex
- W2123436970
- Cited by
- 126
- References
- 0
- Citations by year
- 2025: 1 · 2023: 3 · 2022: 5 · 2021: 5 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 2 · 2015: 3 · 2013: 2 · 2012: 6
- FWCI
- 11.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- University of California, San Francisco
- National Institute of Mental Health (MH 19105, T32MH019105)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
- Keywords
- trimethoprim-sulfamethoxazole resistance, antimicrobial resistance emergence, HIV infection, AIDS, Pneumocystis carinii pneumonia prophylaxis, Staphylococcus aureus, Enterobacteriaceae, Escherichia coli, antibiotic prophylaxis, San Francisco
- MeSH terms
- Adult, Anti-Infective Agents, Anti-Bacterial Agents, Child, Cross-Sectional Studies, Drug Resistance, Microbial, Enterobacteriaceae, Enterobacteriaceae Infections, Humans, Microbial Sensitivity Tests, Pneumonia, Pneumocystis, Staphylococcal Infections, Staphylococcus aureus, HIV Infections, Trimethoprim, Sulfamethoxazole Drug Combination
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