EFFECT OF TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS ON FAECAL CARRIAGE RATES OF RESISTANT ISOLATES OF ESCHERICHIA COLI IN HIV-INFECTED ADULT PATIENTS IN LAGOS.

Authors

  • C. C. Egwuatu Nnamdi Azikiwe University, Nnewi Campus, Nigeria.
  • A. A. Iwuafor
  • T. O. Egwuatu
  • C. N. Akujobi
  • A. U. Nnachi
  • I. N. Aghanya
  • F. T. Ogunsola
  • O.O. Oduyebo

DOI:

https://doi.org/10.21010/ajid.v10i2.12

Keywords:

Trimethoprim- Sulfamethoxazole, HIV, Escherichia coli, Drug resistance, Prophylaxis.

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/mm3 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.

Author Biography

C. C. Egwuatu, Nnamdi Azikiwe University, Nnewi Campus, Nigeria.

Department of Immunology, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Nigeria, PhD Student

Downloads

Published

2016-05-01

How to Cite

Egwuatu, C. C., Iwuafor, A. A., Egwuatu, T. O., Akujobi, C. N., Nnachi, A. U., Aghanya, I. N., Ogunsola, F. T., & Oduyebo, O. (2016). EFFECT OF TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS ON FAECAL CARRIAGE RATES OF RESISTANT ISOLATES OF ESCHERICHIA COLI IN HIV-INFECTED ADULT PATIENTS IN LAGOS. African Journal of Infectious Diseases (AJID), 10(2), 156–163. https://doi.org/10.21010/ajid.v10i2.12

Issue

Vol. 10 No. 2 (2016)

Section

Articles

License

Copyright: Creative Commons Attribution CC BY This license lets others distribute, remix, tweak, and build upon your work, even commercially, as long as they credit you for the original creation. This is the most accommodating of licenses offered. Recommended for maximum dissemination and use of licensed materials. View License Deed | View Legal Code Authors can also self-archive their manuscripts immediately and enable public access from their institution's repository. This is the version that has been accepted for publication and which typically includes author-incorporated changes suggested during submission, peer review and in editor-author communications.