Impact of cotrimoxazole on non-susceptibility to antibiotics in Streptococcus pneumoniae carriage isolates among HIV-infected mineworkers in South Africa
Aurum Institute for Health Research, P. O. Box 61587, Marshalltown, 2107, South Africa; Respiratory and Meningeal Pathogens Research Unit, National Institute for Communicable Diseases, Medical Research Council, De Korte Street, Braamfontein, 2001, South Africa; Hubert Department of Global Health, Rollins School of Public Health, Division of Infectious Diseases, Atlanta, GA 30322, United States; Johns Hopkins University, 1840E Monument Street, Room 401, Baltimore, MD 21205, United States; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E7HT, United Kingdom
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 male, median age 41.5 years, median CD4 290 cells/mm3), 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. © 2007 The British Infection Society.
antibiotic agent; antiretrovirus agent; beta lactam antibiotic; cotrimoxazole; isoniazid; penicillin G; adult; aged; antibiotic prophylaxis; antibiotic sensitivity; article; bacterium carrier; bacterium culture; bacterium detection; bacterium isolate; CD4+ T lymphocyte; controlled study; female; hospitalization; human; human cell; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; miner; minimum inhibitory concentration; nonhuman; nose smear; risk factor; sensitivity and specificity; serotyping; South Africa; Streptococcus infection; Streptococcus pneumoniae; throat culture; tuberculosis; Adult; Anti-Bacterial Agents; Carrier State; CD4 Lymphocyte Count; Cross-Sectional Studies; Drug Resistance, Bacterial; Female; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pharynx; Pneumococcal Infections; Risk Factors; Serotyping; South Africa; Streptococcus pneumoniae; Trimethoprim-Sulfamethoxazole Combination