Impact of cotrimoxazole on non-susceptibility to antibiotics in Streptococcus pneumoniae carriage isolates among HIV-infected mineworkers in South Africa


Pemba, L; Charalambous, S; von Gottberg, A; Magadla, B; Moloi, V; Seabi, O; Wasas, A; Klugman, KP; Chaisson, RE; Fielding, K; Churchyard, GJ; Grant, AD; (2008) Impact of cotrimoxazole on non-susceptibility to antibiotics in Streptococcus pneumoniae carriage isolates among HIV-infected mineworkers in South Africa. The Journal of infection, 56 (3). pp. 171-178. ISSN 0163-4453 DOI: 10.1016/j.jinf.2007.12.003

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Abstract

Objectives: To investigate risk factors for pneumococcal carriage and non-susceptibility among HIV-infected mineworkers in South Africa. Methods: In a cross-sectional study, HIV clinic attendees were questioned about risk factors for pneumococcal carriage and antimicrobial non-susceptibility. Oropharyngeal and nasopharyngeal swabs were taken for pneumococcal culture, serotyping and susceptibility testing. Results: Among 856 participants (854 mate, median age 41.5 years, median CD4 290 cells/ mm(3)), 294 (34.3%) were receiving cotrimoxazole prophylaxis. Overall, 75/856 (8.8%) carried S. pneumoniae; among those taking vs. not taking cotrimoxazole, 8.2% vs. 9.1% were carriers. Risk factors for pneumococcal carriage were living with a child (adjusted OR 2.12, 95% CI 1.06-4.62) and recent hospitalisation (adjusted OR 1.80; 95% CI 0.98-3.30). Among participants not taking cotrimoxazole, the prevalence of carriage was higher in individuals with lower CD4 counts. Comparing participants taking cotrimoxazole vs. not, 60.9% vs. 22.4% (p = 0.001) isolates were non-susceptible to cotrimoxazole and 30.4% vs. 8.2% were non-susceptible to penicillin (p = 0.014). Thirty three/72 (45.8%) isolates were paediatric serotypes/groups. Nasopharyngeal compared with oropharyngeal swabs had higher sensitivity in detecting carriage (53/75, 70.7% vs. 31/75, 41.3%), and adding oropharyngeal sampling increased detection from 6.2% to 8.8%. Conclusions: Non-susceptibility to cotrimoxazole and penicillin was more common among isolates from participants taking cotrimoxazole prophylaxis. Surveillance for antimicrobial susceptibility is important where prophylaxis is used. Treatment for pneumococcal disease should take into account a higher risk of non-susceptibility to antibiotics amongst individuals taking cotrimoxazole prophylaxis. (c) 2007 The British Infection Society. Published by Elsevier Ltd. All rights reserved.

Item Type: Article
Keywords: Adult, Anti-Bacterial Agents, pharmacology, therapeutic use, CD4 Lymphocyte Count, Carrier State, epidemiology, microbiology, Cross-Sectional Studies, Drug Resistance, Bacterial, Female, HIV Infections, complications, immunology, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Pharynx, microbiology, Pneumococcal Infections, epidemiology, microbiology, Risk Factors, Serotyping, South Africa, epidemiology, Streptococcus pneumoniae, classification, drug effects, isolation & purification, Trimethoprim-Sulfamethoxazole Combination, pharmacology, therapeutic use
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Antimicrobial Resistance Centre (AMR)
Tropical Epidemiology Group
PubMed ID: 18262281
Web of Science ID: 254043400002
URI: http://researchonline.lshtm.ac.uk/id/eprint/7946

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