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Trimethoprim resistance in Finland after five years' use of plain trimethoprim
Abstract:
A total of 1388 urinary bacterial pathogens were tested for resistance to plain trimethoprim after five years' use of this drug for prophylaxis against urinary tract infections. Samples were obtained in Turku, Finland, where use of the drug is much greater than in other parts of Finland. Resistance to trimethoprim (greater than 8 mg/l; agar-dilution method) occurred in 20.3% of strains isolated from outpatients and 39.8% of strains isolated from inpatients. Escherichia coli and Micrococcus showed low incidences of resistance (11% and 13% respectively in ouptatients and 23% and 19% respectively in inpatients); Enterobacter, Streptococcus faecalis, and Staphylococcus epidermidis occupied an intermediate position; and Proteus mirabilis and Klebsiella were resistant in 41-76% of cases. Similar incidences of resistance were observed to sulphamethoxazole-trimethoprim, sulphamethoxazole, ampicillin, and nitrofurantoin. These findings together with the rare occurrence of side effects and convenient dosage confirm the usefulness of plain trimethoprim for urinary tract infection.
Insights
Trimethoprim resistance in urinary pathogens increased after five years of use, particularly in hospital settings. Despite rising resistance, trimethoprim remains useful for urinary tract infections due to its safety and efficacy.
Area of Science:
- Urology
- Infectious Diseases
- Pharmacology
Background:
- Urinary tract infections (UTIs) are common, necessitating effective antimicrobial prophylaxis.
- Trimethoprim has been widely used for UTI prophylaxis.
- Monitoring antimicrobial resistance is crucial for guiding treatment strategies.
Purpose of the Study:
- To assess trimethoprim resistance in urinary bacterial pathogens after five years of its prophylactic use.
- To identify specific bacterial species exhibiting resistance patterns.
- To evaluate the continued utility of trimethoprim for UTIs.
Main Methods:
- A total of 1388 urinary bacterial isolates were tested for trimethoprim resistance.
- The agar-dilution method was employed to determine minimum inhibitory concentrations (MICs).
- Resistance was defined as MIC > 8 mg/l.
Main Results:
- Overall trimethoprim resistance was 20.3% in outpatients and 39.8% in inpatients.
- High resistance rates were observed in Proteus mirabilis (41-76%) and Klebsiella.
- Escherichia coli and Micrococcus showed lower resistance rates (11-23%).
- Similar resistance patterns were noted for other antibiotics like co-trimoxazole.
Conclusions:
- Trimethoprim resistance has emerged in urinary pathogens, especially in hospital settings.
- Despite resistance, trimethoprim's favorable side effect profile and dosage support its continued use for UTIs.
- Surveillance of resistance is essential for optimizing UTI management.