title: Dissemination of Trimethoprim-Sulfamethoxazole Drug Resistance Genes Associated with Class 1 and Class 2 Integrons Among Gram-Negative Bacteria from HIV Patients in South India.
abstract: The antibiotic, trimethoprim-sulfamethoxazole (TMP-SMX), is generally used for prophylaxis in HIV individuals to protect them from Pneumocystis jiroveci infection. Long-term use of TMP-SMX develops drug resistance among bacteria in HIV patients. The study was aimed to detect the TMP-SMX resistance genes among gram-negative bacteria from HIV patients. TMP-SMX-resistant isolates were detected by the Kirby-Bauer disc diffusion method. While TMP resistance genes such as dfrA1, dfrA5, dfrA7, and dfrA17 and SMX resistance genes such as sul1 and sul2 were detected by multiplex PCR, class 1 and class 2 integrons were detected by standard monoplex PCR. Of the 151 TMP-SMX-resistant bacterial isolates, 3 were positive for sul1 alone, 48 for sul2 alone, 11 for dfrA7 alone, 21 for sul1 and sul2, 1 for sul1 and dfrA7, 23 for sul2 and dfrA7, 2 for sul2 and dfrA5, 41 for sul1, sul2, and dfrA7, and 1 for sul2, dfrA5, and dfrA7. Of 60 TMP-SMX-resistant isolates positive for integrons, 44 had class 1 and 16 had class 2 integrons. It was found that the prevalence of sul genes (n = 202; p < 0.001) was higher compared with dfr genes (n = 80; p < 0.001), and 87.4% (n = 132; p < 0.001) of TMP-SMX-resistant isolates also were positive for β-lactamase production. This type of study is reported for the first time from HIV patients in India. Therefore, this study indicates that dissemination of TMP-SMX resistance genes and class 1 and class 2 integrons along with β-lactamase production among gram-negative bacteria in HIV patients will certainly make their treatment to bacterial infections more complicated in clinical settings.
authors.affiliation: 1 Post Graduate and Research Department of Microbiology and Biotechnology, Presidency College (Autonomous) , Chennai, India .
authors.forename: Marimuthu Ragavan
authors.initials: MR
authors.lastname: Ramesh Kumar
authors.affiliation: 1 Post Graduate and Research Department of Microbiology and Biotechnology, Presidency College (Autonomous) , Chennai, India .
authors.forename: Narasingam
authors.initials: N
authors.lastname: Arunagirinathan
authors.affiliation: 2 Department of Microbiology, Dr. ALM PGIBMS, University of Madras , Chennai, India .
authors.forename: Seetharaman
authors.initials: S
authors.lastname: Srivani
authors.affiliation: 2 Department of Microbiology, Dr. ALM PGIBMS, University of Madras , Chennai, India .
authors.forename: Aridoss
authors.initials: A
authors.lastname: Dhanasezhian
authors.affiliation: 1 Post Graduate and Research Department of Microbiology and Biotechnology, Presidency College (Autonomous) , Chennai, India .
authors.forename: Nallusamy
authors.initials: N
authors.lastname: Vijaykanth
authors.affiliation: 1 Post Graduate and Research Department of Microbiology and Biotechnology, Presidency College (Autonomous) , Chennai, India .
authors.forename: Natesan
authors.initials: N
authors.lastname: Manikandan
authors.affiliation: 1 Post Graduate and Research Department of Microbiology and Biotechnology, Presidency College (Autonomous) , Chennai, India .
authors.forename: Sethuramalingam
authors.initials: S
authors.lastname: Balakrishnan
authors.affiliation: 3 YRG Centre for AIDS Research and Education (YRG CARE), Voluntary Health Services Hospital Campus , Chennai, India .|4 Laboratory-Based Department, Faculty of Medicine, Universiti Kuala Lumpur Royal College of Medicine Perak (UniKL RCMP) , Ipoh, Malaysia .
authors.forename: Ramachandran
authors.initials: R
authors.lastname: Vignesh
authors.affiliation: 3 YRG Centre for AIDS Research and Education (YRG CARE), Voluntary Health Services Hospital Campus , Chennai, India .
authors.forename: Pachamuthu
authors.initials: P
authors.lastname: Balakrishnan
authors.affiliation: 3 YRG Centre for AIDS Research and Education (YRG CARE), Voluntary Health Services Hospital Campus , Chennai, India .
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.affiliation: 3 YRG Centre for AIDS Research and Education (YRG CARE), Voluntary Health Services Hospital Campus , Chennai, India .
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Solomon
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D060085:Coinfection; D052978:Disk Diffusion Antimicrobial Tests; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D004755:Enterobacteriaceae / Q000187:drug effects / Q000235:genetics* / Q000254:growth & development / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology; D015964:Gene Expression Regulation, Bacterial; D005798:Genes, Bacterial; D015658:HIV Infections / Q000276:immunology / Q000821:virology; D006801:Humans; D007194:India; D032023:Integrons; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology*; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D001618:beta-Lactamases
keywords: AmpC; ESBLs; HIV; MBL; TMP-SMX; dfrA7; integrons; sul1; trimethoprim-sulfamethoxazole