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Abstract:
Of 320 patients surveyed in a general hospital's medical wards during a 6-month period in 1981, 18 (5.6%) harboured enterobacteria which contained resistance plasmids conferring resistance to trimethoprim (Tp). At the beginning of the study period, Tp-containing therapy was not the first choice for treatment of infections caused by these bacteria and the incidence of plasmid-determined resistance was 10%. When Tp alone was used as the first choice of treatment of urinary tract infections and the use of this antimicrobial was correspondingly increased, the proportion of strains that contained Tp resistance plasmids (R-plasmids) decreased to 4%. Relatively more patients with Tp-resistant strains in the bowel had significant bacteriuria compared with those without Tp-resistant organisms. The continuing occurrence of Tp-R-plasmid containing strains in the gut was associated with continuing antimicrobial therapy; the strains generally disappeared after antimicrobial therapy was stopped.
Insights
Trimethoprim resistance in enterobacteria decreased when trimethoprim (Tp) was prioritized for urinary tract infections. Continued antimicrobial therapy correlated with persistent trimethoprim-resistant (Tp-R) strains, which resolved upon cessation of treatment.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Enterobacteria carrying resistance plasmids pose a significant challenge in hospital settings.
- Trimethoprim (Tp) resistance, often plasmid-mediated, impacts treatment efficacy for bacterial infections.
Purpose of the Study:
- To investigate the prevalence of trimethoprim resistance in enterobacteria within a general hospital.
- To assess the impact of changing treatment strategies on the incidence of trimethoprim resistance plasmids (R-plasmids).
Main Methods:
- Survey of 320 patients in medical wards over a 6-month period.
- Identification of enterobacteria harboring resistance plasmids conferring trimethoprim resistance.
- Correlation of antimicrobial therapy patterns with the prevalence of Tp-resistant strains.
Main Results:
- Initially, 5.6% of patients harbored enterobacteria with trimethoprim resistance plasmids (R-plasmids).
- When trimethoprim (Tp) became the first-choice treatment for urinary tract infections, the incidence of Tp-R-plasmid strains decreased to 4%.
- Persistent antimicrobial therapy was associated with the continued presence of Tp-R-plasmid strains in the gut.
Conclusions:
- Strategic use of trimethoprim can reduce the prevalence of trimethoprim-resistant enterobacteria.
- Antimicrobial stewardship is crucial, as continuous therapy promotes the persistence of resistant strains.
- Discontinuation of antimicrobial therapy facilitates the clearance of trimethoprim-resistant organisms.