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Epidemiology of resistance to diaminopyrimidines
1Hôpital Saint-Joseph, Laboratoire de Microbiologie Médicale, Paris, France.
Abstract:
Resistance to trimethoprim emerged in Enterobacteriaceae and later in other Gram-negative and Gram-positive bacteria within two years of the clinical introduction of the drug. Resistance is borne in many different replicons often present in multiply-resistant epidemic bacteria. The incidence of trimethoprim resistance is highly variable, depending upon methodology, type of patients, local epidemiology: this can be illustrated by the high variation of trimethoprim resistance among Salmonella, Shigella or MRSA in various countries and by the incidence of resistance in penicillin-resistant Streptococcus pneumoniae.
Insights
Trimethoprim resistance rapidly emerged in bacteria, often on mobile genetic elements. Resistance incidence varies significantly based on bacterial species, patient populations, and geographic location.
Area of Science:
- Microbiology
- Bacterial genetics
- Antimicrobial resistance
Background:
- Trimethoprim is a widely used antibiotic.
- Bacterial resistance to antibiotics is a growing global health concern.
- The emergence and spread of trimethoprim resistance are critical to monitor.
Purpose of the Study:
- To investigate the emergence and spread of trimethoprim resistance in bacteria.
- To identify the genetic basis and epidemiological factors influencing trimethoprim resistance.
- To highlight the variability in trimethoprim resistance incidence across different bacterial species and settings.
Main Methods:
- Literature review and synthesis of existing data on trimethoprim resistance.
- Analysis of resistance patterns in various bacterial species, including Enterobacteriaceae, Gram-negative, and Gram-positive bacteria.
- Examination of the role of different replicons and epidemic strains in resistance dissemination.
Main Results:
- Trimethoprim resistance emerged rapidly, within two years of clinical use, in Enterobacteriaceae and subsequently in other bacteria.
- Resistance determinants are frequently located on various replicons, often found in multiply-resistant epidemic bacteria.
- The incidence of trimethoprim resistance shows significant variability, influenced by methodology, patient demographics, and local epidemiology, as seen in Salmonella, Shigella, MRSA, and Streptococcus pneumoniae.
Conclusions:
- Trimethoprim resistance is a well-established and evolving challenge in bacterial infections.
- The presence of resistance on mobile genetic elements facilitates its rapid spread.
- Understanding the epidemiological factors influencing resistance is crucial for effective antimicrobial stewardship.