Applied Epidemiology Program, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania.
Am J Trop Med Hyg. 2024 May 28;111(1):43-47. doi: 10.4269/ajtmh.23-0824. Print 2024 Jul 3.
Increasing antimicrobial resistance (AMR) is a global public health emergency. Although chemoprevention has improved malaria-related pregnancy outcomes, the downstream effects on AMR have not been characterized. We compared the abundance of 10 AMR genes in stool samples from pregnant women receiving sulfadoxine-pyrimethamine (SP) as intermittent preventive treatment against malaria in pregnancy (IPTp) to that in samples from women receiving dihydroartemisinin-piperaquine (DP) for IPTp. All participants had at least one AMR gene at baseline. Mean quantities of the antifolate gene dfrA17 were increased after two or more doses of SP (mean difference = 1.6, 95% CI: 0.4-2.7, P = 0.008). Antimicrobial resistance gene abundance tended to increase from baseline in SP recipients compared with a downward trend in the DP group. Overall, IPTp-SP had minimal effects on the abundance of antifolate resistance genes (except for dfrA17), potentially owing to a high starting prevalence. However, the trend toward increasing AMR in SP recipients warrants further studies.
抗微生物药物耐药性（AMR）不断增加是全球公共卫生紧急事件。虽然化学预防已改善了与疟疾相关的妊娠结局，但尚未对其对抗微生物药物耐药性的下游影响进行特征描述。我们比较了接受磺胺多辛-乙胺嘧啶（SP）作为妊娠期间间歇性预防治疗（IPTp）的孕妇的粪便样本中 10 种 AMR 基因的丰度与接受二氢青蒿素-哌喹（DP）进行 IPTp 的妇女的样本中的丰度。所有参与者在基线时至少有一种 AMR 基因。接受两剂或更多剂 SP 后，叶酸拮抗剂基因 dfrA17 的平均数量增加（平均差异=1.6，95%CI：0.4-2.7，P=0.008）。与 DP 组的下降趋势相比，SP 组的抗微生物药物耐药性基因丰度从基线开始呈上升趋势。总体而言，IPTp-SP 对叶酸拮抗剂耐药基因（除 dfrA17 外）的丰度影响不大，这可能是由于起始流行率较高。然而，SP 组抗微生物药物耐药性增加的趋势需要进一步研究。
