Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
PLoS One. 2020 Dec 7;15(12):e0243054. doi: 10.1371/journal.pone.0243054. eCollection 2020.
Infections caused by antibiotic-resistant bacteria results in high rates of morbidity and mortality. Although the prolonged cotrimoxazole (CTX) prophylaxis is arguably associated with the risk of increasing drug resistance in the common pathogens, information regarding its impact on Streptococci pneumoniae / pneumococcus is very limited.
This study was conducted to investigate the effect of cotrimoxazole prophylaxis on nasopharyngeal colonization rate and antimicrobial resistance using Streptococci pneumoniae (pneumococcus) as an indicator organism among HIV patients in Arba Minch, Ethiopia.
A comparative cross-sectional study was designed and conducted among HIV patients attending the Anti-Retroviral Treatment (ART) clinic of Arba Minch General Hospital (AMGH) from April 01 to August 31, 2018. A total of 252 participants were systematically selected and clustered into two study groups based on their CTX prophylaxis status, one taking CTX prophylaxis, and the second one, the control group (without prophylaxis). A structured questionnaire was used to collect socio-demographic and clinical data from patients. A nasopharyngeal swab was collected and cultured for pneumococcal isolation and identification in accordance with standard microbiological techniques. An antibiotics sensitivity test was performed according to the CLSI guidelines. Data were analyzed using the Statistical package for social science (SPSS) version 20. The primary outcome was determined using logistic regression analysis.
Of the 252 enrolled HIV patients (mean age (37.38± 9.03 years), 144 (57.14%) were males. The overall, nasopharyngeal colonization rate of S. pneumoniae was 13.5% (95% CI: 8.4-15.6). Asymptomatic pneumococcal carriage rates among patients on CTX prophylaxis and the control group were 16.3%, and 10.3% respectively (p-value = 0.03). Regarding the risk factors analyzed, CTX prophylaxis (AOR: 2.2; 95% CI: 1.05-4.9) and gender (AOR: 2.5; 95% CI: 1.09-5.93) were significantly associated with pneumococcal colonization, showing a male preponderance. Cotrimoxazole-resistant pneumococci were 85.7% vs. 47.4% in the prophylaxis group and the control group respectively and it was statistically significant (AOR: 6.7; 95% CI: 1.3-36). Percentages of multi-drug resistant isolates in these two groups were 38.09 and 15.38 respectively (p-value = 0.04). Among the CTX resistant pneumococci isolates, 85% were also found to be co-resistant towards penicillin and was statistically significant.
The percentage prevalence of nasopharyngeal pneumococci colonization was higher in patients taking CTX prophylaxis. It was noted that CTX prophylaxis eventually results in the selection of cotrimoxazole resistance and multi-drug resistance in pneumococci. There is evidence of existing cross-resistance between cotrimoxazole and penicillin antibiotics. Therefore, CTX prophylaxis must be administered judiciously. Surveillance for antimicrobial susceptibility is warranted where the prophylaxis is common.
抗生素耐药菌引起的感染导致发病率和死亡率居高不下。虽然长期使用复方新诺明（CTX）预防可能会增加常见病原体的耐药风险，但关于其对肺炎链球菌/肺炎球菌影响的信息非常有限。
本研究旨在调查CTX 预防对 nasopharyngeal 定植率和抗菌药物耐药性的影响，以肺炎链球菌作为埃塞俄比亚阿尔巴明奇艾滋病毒患者的指示生物。
设计并进行了一项比较性横断面研究，在 2018 年 4 月 1 日至 8 月 31 日期间，在阿尔巴明奇综合医院（AMGH）的抗逆转录病毒治疗（ART）诊所对 HIV 患者进行了研究。共有 252 名参与者被系统地选择，并根据他们的 CTX 预防状况分为两组，一组服用 CTX 预防，另一组为对照组（无预防）。使用结构化问卷从患者中收集社会人口统计学和临床数据。按照标准微生物学技术采集鼻咽拭子进行肺炎链球菌分离和鉴定。根据 CLSI 指南进行抗生素敏感性试验。使用社会科学统计软件包（SPSS）版本 20 进行数据分析。使用逻辑回归分析确定主要结果。
在 252 名入组的 HIV 患者中（平均年龄（37.38±9.03）岁），144 名（57.14%）为男性。总的来说，肺炎链球菌鼻咽定植率为 13.5%（95%CI：8.4-15.6）。CTX 预防组和对照组无症状肺炎球菌携带率分别为 16.3%和 10.3%（p 值=0.03）。关于分析的危险因素，CTX 预防（AOR：2.2；95%CI：1.05-4.9）和性别（AOR：2.5；95%CI：1.09-5.93）与肺炎球菌定植显著相关，表现出男性优势。CTX 耐药肺炎球菌分别为预防组和对照组的 85.7%和 47.4%，差异有统计学意义（AOR：6.7；95%CI：1.3-36）。两组多药耐药分离株的百分比分别为 38.09%和 15.38%（p 值=0.04）。在 CTX 耐药肺炎球菌分离株中，85%也对青霉素表现出协同耐药，差异有统计学意义。
接受 CTX 预防的患者鼻咽肺炎球菌定植率较高。值得注意的是，CTX 预防最终导致肺炎球菌对复方新诺明和多药耐药的选择。CTX 和青霉素抗生素之间存在交叉耐药的证据。因此，CTX 预防必须谨慎使用。在预防措施普遍存在的情况下，需要进行抗生素敏感性监测。
