Sex Transm Infect. 2008 Oct;84(5):352-5. Epub 2008 Jul 2.
Escalation in the relative prevalence of
ciprofloxacin-resistant gonorrhoea among
men with urethral discharge in two South
African cities: association with HIV
seropositivity.
Lewis DA, Scott L, Slabbert M, Mhlongo S, van Zijl A, Sello M, du Plessis N, Radebe F,
Wasserman E.
Source
STI Reference Centre, National Institute for Communicable Diseases, Private Bag X4,
Sandringham 2131, South Africa. davidl@nicd.ac.za
Abstract
OBJECTIVES:
The objectives of this study were to assess the prevalence of ciprofloxacin-resistant
gonorrhoea in two South African cities and to investigate the association between the isolation
of ciprofloxacin-resistant Neisseria gonorrhoeae and the HIV serostatus of patients.
METHODS:
Gonococci were cultured from endourethral swabs taken from consecutive men with urethritis
attending clinics in Johannesburg and Cape Town. Minimum inhibitory concentrations (MIC)
for ciprofloxacin and ceftriaxone were determined with E-tests. Isolates with a ciprofloxacin
MIC of 1 mg/l or greater were defined as resistant and isolates with a ceftriaxone MIC of 0.25
mg/l or less were defined as susceptible. Rapid tests were used to screen and confirm the
presence of HIV antibodies. Survey data from 2004 were used as a baseline to assess trends in
gonococcal resistance to ciprofloxacin.
RESULTS:
In 2004, the prevalence of ciprofloxacin resistance was 7% in Cape Town and 11% in
Johannesburg. In 2007, 37/139 (27%) Cape Town isolates and 47/149 (32%) Johannesburg
isolates were resistant to ciprofloxacin; in comparison with 2004 data, this represents 2.9-fold
and 1.9-fold increases, respectively. All isolates were fully susceptible to ceftriaxone. There
was a significant association between HIV seropositivity and the presence of ciprofloxacinresistant gonorrhoea among patients (p = 0.034).
CONCLUSIONS:
Johannesburg and Cape Town have witnessed significant rises in the prevalence of
ciprofloxacin-resistant gonorrhoea among men with urethritis. The resistant phenotype is
linked to HIV seropositivity. There is now an urgent need to change national first-line therapy
for presumptive gonococcal infections within South Africa.
PMID:
18596070
[PubMed - indexed for MEDLINE]
Supplemental Content
Front Microbiol. 2012;3:67. Epub 2012 Feb 22.
Distribution of quinolones, sulfonamides,
tetracyclines in aquatic environment and
antibiotic resistance in indochina.
Suzuki S, Hoa PT.
Source
Center for Marine Environmental Studies, Ehime University Matsuyama, Ehime, Japan.
Abstract
Southeast Asia has become the center of rapid industrial development and economic growth.
However, this growth has far outpaced investment in public infrastructure, leading to the
unregulated release of many pollutants, including wastewater-related contaminants such as
antibiotics. Antibiotics are of major concern because they can easily be released into the
environment from numerous sources, and can subsequently induce development of antibioticresistant bacteria. Recent studies have shown that for some categories of drugs this source-toenvironment antibiotic resistance relationship is more complex. This review summarizes
current understanding regarding the presence of quinolones, sulfonamides, and tetracyclines
in aquatic environments of Indochina and the prevalence of bacteria resistant to them. Several
noteworthy findings are discussed: (1) quinolone contamination and the occurrence of
quinolone resistance are not correlated; (2) occurrence of the sul sulfonamide resistance gene
varies geographically; and (3) microbial diversity might be related to the rate of
oxytetracycline resistance.
PMID:
22363337
[PubMed - in process]
PMCID:
PMC3283837
Free PMC Article
LinkOut - more resources
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Supplemental Content
PLoS One. 2008 Mar 19;3(3):e1772.
Clinical and microbiological features of
HIV-associated tuberculous meningitis in
Vietnamese adults.
Torok ME, Chau TT, Mai PP, Phong ND, Dung NT, Chuong LV, Lee SJ, Caws M, de Jong
MD, Hien TT, Farrar JJ.
Source
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City,
Vietnam. etorok@oucru.org
Abstract
METHODS:
The aim of this prospective, observational cohort study was to determine the clinical and
microbiological features, outcome, and baseline variables predictive of death, in Vietnamese
adults with HIV-associated tuberculous meningitis (TBM). 58 patients were admitted to the
Hospital for Tropical Diseases in Ho Chi Minh City and underwent routine clinical and
laboratory assessments. Treatment was with standard antituberculous therapy and adjunctive
dexamethasone; antiretroviral therapy was not routinely available. Patients were followed up
until the end of TB treatment or death.
RESULTS:
The median symptom duration was 11 days (range 2-90 days), 21.8% had a past history of
TB, and 41.4% had severe (grade 3) TBM. The median CD4 count was 32 cells/mm(3). CSF
findings were as follows: median leucocyte count 438 x 10(9)cells/l (63% neutrophils), 69%
smear positive and 87.9% culture positive. TB drug resistance rates were high (13% monoresistance 32.6% poly-resistance 8.7% multidrug resistance). 17% patients developed further
AIDS-defining illnesses. 67.2% died (median time to death 20 days). Three baseline variables
were predictive of death by multivariate analysis: increased TBM grade [adjusted hazard ratio
(AHR) 1.73, 95% CI 1.08-2.76, p = 0.02], lower serum sodium (AHR 0.93, 95% CI 0.89 to
0.98, p = 0.002) and decreased CSF lymphocyte percentage (AHR 0.98, 95% CI 0.97 to 0.99,
p = 0.003).
CONCLUSIONS:
HIV-associated TBM is devastating disease with a dismal prognosis. CSF findings included
CSF neutrophil predominance, high rates of smear and culture positivity, and high rates of
antituberculous drug resistance. Three baseline variables were independently associated with
death: increased TBM grade; low serum sodium and decreased CSF lymphocyte percentage.
Supplemental Content
Clinical deterioration during antitubercular
treatment at a district hospital in South
Africa: the importance of drug resistance
and AIDS defining illnesses.
Pepper DJ, Rebe K, Morroni C, Wilkinson RJ, Meintjes G.
Source
Department of Medicine, University of Cape Town, Cape Town, South Africa.
dominiquepepper@gmail.com
Abstract
BACKGROUND:
Clinical deterioration on drug therapy for tuberculosis is a common cause of hospital
admission in Africa. Potential causes for clinical deterioration in settings of high HIV-1
prevalence include drug resistant Mycobacterium tuberculosis (M.tb), co-morbid illnesses,
poor adherence to therapy, tuberculosis associated-immune reconstitution inflammatory
syndrome (TB-IRIS) and subtherapeutic antitubercular drug levels. It is important to derive a
rapid diagnostic work-up to determine the cause of clinical deterioration as well as specific
management to prevent further clinical deterioration and death. We undertook this study
among tuberculosis (TB) patients referred to an adult district level hospital situated in a high
HIV-1 prevalence setting to determine the frequency, reasons and outcome for such clinical
deterioration.
METHOD:
A prospective observational study conducted during the first quarter of 2007. We defined
clinical deterioration as clinical worsening or failure to stabilise after 14 or more days of
antitubercular treatment, resulting in hospital referral. We collected data on tuberculosis
diagnosis and treatment, HIV-1 status and antiretroviral treatment, and investigated reasons
for clinical deterioration as well as outcome.
RESULTS:
During this period, 352 TB patients met inclusion criteria; 296 were admitted to hospital
accounting for 17% of total medical admissions (n = 1755). Eighty three percent of TB
patients (291/352) were known to be HIV-1 co-infected with a median CD4 count of
89cells/mm(3) (IQR 38-157). Mortality among TB patients admitted to hospital was 16% (n =
48). The median duration of hospital admission was 9.5 days (IQR 4-18), longer than routine
in this setting (4 days). Among patients in whom HIV-1 status was known (n = 324), 72% of
TB patients (n = 232) had an additional illness to tuberculosis; new AIDS defining illnesses (n
= 80) were the most frequent additional illnesses (n = 208) in HIV-1 co-infected patients (n =
291). Rifampin-resistant M.tb (n = 41), TB-IRIS (n = 51) and drug resistant bacterial
infections (n = 12) were found in 12%, 14% and 3.4% of the 352 cases, respectively.
INTERPRETATION:
In our setting, new AIDS defining illnesses, drug resistant M.tb and other drug resistant
bacteria are important reasons for clinical deterioration in HIV-1 co-infected patients
receiving antitubercular treatment. HIV-1 co-infected patients may be at increased risk of
acquiring nosocomial drug resistant pathogens because profound immune suppression results
in co-morbid illnesses that require prolonged inpatient admissions. Routine infection control
is essential and needs to be strengthened in our setting.
Supplemental Content
Antimicrob Agents Chemother. 2002 Feb;46(2):594-7.
Impact of trimethoprim-sulfamethoxazole
prophylaxis on etiology and
susceptibilities of pathogens causing
human immunodeficiency virusassociated bacteremia.
Wininger DA, Fass RJ.
Source
Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University
College of Medicine and Public Health, Columbus, Ohio 43210, USA. winninger1@medctr.osu.edu
Abstract
The impact of chronic prophylactic administration of trimethoprim-sulfamethoxazole (SXT)
on the ecology and the antimicrobial susceptibilities of bloodstream pathogens in human
immunodeficiency virus (HIV)-infected patients was studied using a retrospective chart
review. Eighty-nine patients with advanced HIV infection developed 124 episodes of
bacteremia with 156 pathogenic isolates. Staphylococcus aureus and Enterobacteriaceae
tended to be less common among patients receiving SXT. Isolates from patients receiving
SXT were likelier (75%) to be resistant to 20 microg of SXT/ml than those from patients not
receiving SXT (33%) (P < 0.001).
Supplemental Content
J Glob Infect Dis. 2010 Sep;2(3):284-90.
Cephalosporin Resistance in Neisseria
gonorrhoeae.
Bala M, Sood S.
Source
Regional STD Teaching Training and Research Centre, Vardhman Mahavir Medical College
and Safdarjang Hospital, New Delhi, India.
Abstract
Gonorrhea, a disease of public health importance, not only leads to high incidence of acute
infections and complications but also plays a major role in facilitating human
immunodeficiency virus (HIV) acquisition and transmission. One of the major public health
needs for gonorrhea control is appropriate, effective treatment. However, treatment options
for gonorrhea are diminishing as Neisseria gonorrhoeae have developed resistance to several
antimicrobial drugs such as sulfonamides, penicillin, tetracyclines and quinolones.
Antimicrobial resistance (AMR) surveillance of N. gonorrhoeae helps establish and maintain
the efficacy of standard treatment regimens. AMR surveillance should be continuous to reveal
the emergence of new resistant strains, monitor the changing patterns of resistance, and be
able to update treatment recommendations so as to assist in disease control. Current treatment
guidelines recommend the use of single dose injectable or oral cephalosporins. The
emergence and spread of cephalosporin resistant and multi drug resistant N. gonorrhoeae
strains, represents a worrying trend that requires monitoring and investigation. Routine
clinical laboratories need to be vigilant for the detection of such strains such that strategies for
control and prevention could be reviewed and revised from time to time. It will be important
to elucidate the genetic mechanisms responsible for decreased susceptibility and future
resistance. There is also an urgent need for research of safe, alternative anti-gonococcal
compounds that can be administered orally and have effective potency, allowing high
therapeutic efficacy (greater than 95.0% cure rate).
Supplemental Content
West Indian Med J. 2010 Jul;59(4):386-92.
Antibiotic resistance among pathogens
causing disease in Jamaican children with
HIV/AIDS.
Byam PR, Pierre RB, Christie CD, Andiman WA, Pettigrew M; Kingston Paediatric and
Perinatal HIV/AIDS (KPAIDS) Study Group.
Source
Yale School of Public Health, The University of the West Indies, Kingston 7, Jamaica.
Abstract
OBJECTIVE:
There are limited data regarding the antimicrobial resistance patterns of pathogens in children
with HIV/AIDS from developing countries. We aimed to determine the prevalence and
antibiotic susceptibility patterns of bacterial pathogens causing urinary tract infections (UTIs)
and sepsis in a cohort of 219 HIV-infected Jamaican children.
METHODS:
This cross-sectional study examined clinical and microbiological data for children enrolled in
the Kingston Paediatric/Perinatal HIV/AIDS programme from September 1, 2002 to May 31,
2007. Cases were defined as physician-diagnosed, laboratory confirmed UTIs and sepsis
based on Centers for Disease Control and Prevention (CDC) criteria. Only isolates from urine,
blood and sterile sites were considered.
RESULTS:
Forty-four patients (20.1%) accounted for 74 episodes of UTIs and sepsis. Mean number of
infections was 1.7 +/- 1.3 per patient. There were 31 males (70.5%) and mean age at time of
infection was 5.6 +/- 4.7 years. Bacterial infections comprised cystitis (n = 52, 70.3%),
bacterial pneumonia (n = 15, 20.3%), meningitis (n = 4, 5.4%), septicaemia (n = .2, 2.7%) and
bone infection (n = 1, 1.4%). Among 52 UTIs, 39 were caused by a single organism. The
most common UTI isolates included Escherichia coli (n = 21, 53.8%) and Enterobacter spp (n
= 5, 12.8%). Among 22 cases of sepsis, isolates included Streptococcus pneumoniae (n = 8,
36.4%) and coagulase negative Staphylococcus (n = 6, 27.3%). All E coli isolates at two of
three clinical sites were resistant to cotrimoxazole. There were 79.7% (n = 51) of infectious
episodes with a cotrimoxazole-resistant organism occurring among those on cotrimoxazole
prophylaxis.
CONCLUSIONS:
Escherichia coli was the most frequent bacterial isolate. Cotrimoxazole is a poor choice for
empiric treatment of sepsis and UTIs in this clinical setting.
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