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Previous exposure to prophylactic co-trimoxazole and resistance in bacteria from HIV-positive children: absence of resistance selection pressure of co-trimoxazole

Abstract number: P2068

Kalavsky E., Liskova A., Benca J., Seng Duong L.

Introduction: Co-trimoxazole (COT) prophylaxis and ART (Antiretroviral Therapy) showed clear clinical benefit on mortality. We screened 4 years 62 HIV positive children receiving COT prophylaxis for antimicrobial resistance.

Methods: Sixty two (62) HIV/AIDS positive children from 2 orphanages in Phnom Penh (House of Family and House of Smile) on HAART (Highly Active Antiretroviral Therapy) treated with combination of stavudin, lamivudin and efavirenz for 18–42 months were examined in 3 months periods. Swabs from respiratory tract were obtained and transported in ice box within 24 hours to Reference Laboratory for Antibiotic Resistance in Slovak Republic in Nitra.

Results: Relatively high level of antimicrobial resistance – high occurrence of MRSA (Meticillin resistant S. aureus), PRP (Penicillin resistant pneumococci), ESBL-producing Enterobacteriaceae were observed in children before they started therapy or prophylaxis with COT and before treated with any antibiotic or antituberculotic agents for opportunistic infections. Prior exposure of COT as prevention of PCP (Pneumocystis carinii pneumonia) did not contribute to antimicrobial resistance in HIV children. Our results suggest that consumption of COT neither in prophylaxis nor in therapy did not contribute to increasing occurrence of Gram-positive (MRSA, PRP) or Gram-negative isolates (ESBL, CIP-R, COT-R E. coli, Proteus spp.). Similarly, concomitantly administered antibiotics (in short course, in all cases less than 10 days) in combination with COT were not significantly associated with increase of colonisation or infection with any of assessed resistotypes. Exception was amoxicillin together with COT which was associated with MRSA (P = 0.04).

Conclusion: In conclusion, neither COT alone, nor in combination with antibiotic or antituberculotic agents (RIF, INH, PZA) contribute to increased antibiotic resistance in respiratory isolates from children with HIV/AIDS. Prior exposure to oral cephalosporins and aminopenicilins insignificantly increased occurrence of PRP.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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