title: 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.
authors.affiliation: Center for AIDS Prevention Studies and Department of Epidemiology and Biostatistics, University of California, San Francisco, USA. martin@psg.ucsf.edu
authors.forename: J N
authors.initials: JN
authors.lastname: Martin
authors.forename: D A
authors.initials: DA
authors.lastname: Rose
authors.forename: W K
authors.initials: WK
authors.lastname: Hadley
authors.forename: F
authors.initials: F
authors.lastname: Perdreau-Remington
authors.forename: P K
authors.initials: PK
authors.lastname: Lam
authors.forename: J L
authors.initials: JL
authors.lastname: Gerberding
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000890:Anti-Infective Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000150:complications / Q000382:microbiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008826:Microbial Sensitivity Tests; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control; D013203:Staphylococcal Infections / Q000150:complications / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination