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Reversibility of antimicrobial resistance in respiratory isolates in HIV-positive Cambodian children after 42 months of HAART

Abstract number: P2073

Shahum A., Benca J., Kalavska A., Havlikova Z., Liskova A., Kalavsky E., Beno P., Gulasova I., Krcmery V.

Objectives: Aim of this study was to assess, if restauration of the immune system after 42 months treatment with HAART in Cambodian children has an impact on antibiotic resistance and its reversibility.

Methods: Study participants were HIV positive Cambodian children treated with HAART stavudine, lamivudine and nevirapine or efavirenz. Respiratory tract isolates (nose, pharyngeal, ear svabs) from cambodian previously ART naive children 3–11 years old were assessed every 3 months within 42 months of HAART.

Results: Analysing relationship between duration of HAART, and colonisation with any specific resistance pattern, MRSA appeared to emerge after 6–12 months of HAART in comparison to pre-HAART period (was 90–93% after 9–12 months vs 50% in HAART naive) and slightly decreased to 63% after 42 months. Proportion was biphasic. Presence of multiresistant Klebsiella, and Enterobacter spp. was high already at baseline and in first months of HAART and the proportion of multiresistant Gram-negative bacteria (MR GNB) decreased later to 14.4% after 42 months. Susceptibility of both Gram-negative and Gram-positive bacteria showed biphasic but increasing tendency. Proportion of MR GNB decreased from 21/23 (90%) in the first 6 months of HAART, to 0–11% in those receiving HAART for 15–18 months and to 14% after 42 months of HAART. Reversibility of MR in GNB took 15–18 months. However, the baseline of resistance in GNB were relatively high. Proportion of MRSA increased from 50–55% in first 6 months to 93–85.7% after 9–18 months but than decreased. Emergence of MRSA was slower. Reversibility of MR in St. aureus was longer and took approximately 24–30 months. Ratio of Gram-positive to Gram-negative decreased from 1:3.9 (HAART naive) to 1:1.2 (42 month of HAART).

Conclusion: Reversibility of resistance among isolates from respiratory system was probably due to the reconstitution of their immune system due to the HAART and therefore less exposition with therapeutic ATB. In MRSA, the reversibility of resistance took 15–21 months and was slower than in MR Gram-negative bacilli (Klebsiella, Enterobacter) where the increase of susceptibility (and the decrease of resistance) took 9–12 months. Prophylactic administration of cotrimoxazol 3× weekly did not affect the reversibility of resistance and seems to be less promotive for antibiotic resistance.

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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