Table 2.
Summary of Studies that Met the Inclusion Criteria
| Results | |||||
| Author Study locationStudy design | Study population and size | Comparison group (Type 1 or Type 2)c | Reported outcomes | Prevalence of antibiotic resistance by group or Relative Risk/Odds Ratio (95% Cl) | Study conclusions |
| Crum-Cianflone et al 2007 [20] USA Cohort | HIV-positive adult outpatients with controls who were not on CTX. Duration on CTX not given. N=435 | Type 2 | Community-acquired infection with Methicillin-Resistant Staphylococcus Aureas (MRSA) | CTX=0/29 (0%) CNTL=49/404 (12%) P=.06 RR not reported | CTX ↓ MRSA |
| Mathews et al 2005 [23] USA Cohort | HIV-positive adult patients who had been on CTX for at least 120 days. Controls had been on CTX for less than 120 days (reference in RR calculation). N=3,455 | Type 2 | Initial episode of clinically significantb MRSA infection during the study period | Prevalence not reported Unadjusted RR 0.4a Adjusted RR .3 (0.1–.7)baNo confidence interval given for unadjusted effect bAdjusted for race, HIV disease progression, and antiretroviral drug therapy | CTX ↓ MRSA infection |
| Jordano et al 2004 [21] Spain Cohort | HIV-positive adult patients (duration on CTX not given), with controls who were not on CTX. N=57 | Type 1 | Infection with pneumococcal bacterial strains with resistance to penicillin | CTX=60%c CNTL=38.5% P=.09 RR not reported cNo numbers given | CTX ↑ pneumococcal resistance to penicillin |
| Hamel et al 2008a [16] Kenya Cohort | HIV-positive adults with low CD4+ cells. Exposed to CTX for six months. N=1,160 | Type 1 | Among patients colonized with pneumoccocus, comparison of prevalence of pneumococcal resistance to penicillin at baseline with that at 6 months after initiation of CTX prophylaxis | CTX=85% CNTL=85% RR not reported | No change in pneumococcal resistance to penicillin |
| Gill et al 2008a [17] Zambia Cohort | Infants born to HIV-positive mothers who were given CTX from six weeks of age and followed up to age 18 months (HIV-exposed infants) with HIV-unexposed infants as controls. N=260 | Type 1 | Among infants colonized by S. Pneumoniae comparison of resistance levels to each of the following drugs: clindamycin, penicillin, erythromycin, tetracycline, chloramphenicol | Prevalence not reported Unadjusted RRd; 1.6 (1.0–2.6)d 1.1 (0.7–1.7) 1.0 (0.6–1.7) 0.9 (0.6–1.5) 0.8 (0.3–2.3) dRR are for each of the following drugs respectively: Clindamycin, penicillin, erythromycin, tetracycline, Chloramphenicol RR remained the same after adjusting for confounders | ↑ resistance to clindamycin but no change in pneumococcal resistance to penicillin, erythromycin, tetracycline, and Chloramphenicol |
| Madhi et al 2000 [22] South Africa cohort | HIV-positive children. Controls were also HIV positive who were not on CTX for unspecified reasons. Duration on CTX not given. N=146. | Type 1 | Infection with S. Pneumoniae resistant to penicillin, cefotaxime, TMP-SMX, tetracycline, chloramphenicol, erythromycin, clindamycin, rifampicin | Cotrimoxazole prophylaxis had no impact on resistance to other antibiotics, no other data given | CTX had no impact on pneumococcal resistance to other antibiotics |
| Drapeau et al 2007 [24] Italy case-control | HIV-positive patients admitted to a hospital in Italy. Duration on CTX not given. N=81 | Type 2 | Cases were defined as HIV-positive patients who developed clinically significantb MRSA infection. Controls were HIV-positive patients who did not develop MRSA | Prevalence not applicable Unadjusted OR 3.06 (.99–9.41) Adjusted OR not given | CTX ↑ MRSA |
| Lee et al 2005 [25] USA case-control | HIV-positive MSM receiving care at three participating clinics in Los Angeles County. Duration on CTX not given. N=111 | Type 2 | A case was the onset of a culture-positive MRSA skin infection in an HIV-positive MSM. A control was an HIV-positive MSM without skin symptoms | Prevalence not applicable Unadjusted OR .3 (0.1–.9) Adjusted OR .2 (0.1–.8)ffAdjusted for history of hospitalization, race and ethnicity, and number of sex partner | CTX ↓ MRSA |
| Meynard et al 1996 [26] France case-control | Hospitalised HIV-positive patients. Duration on CTX not given. N=45 | Type 1 | Cases were patients with S. Pneumoniae isolates that were intermediately or fully resistant to penicillin; and controls were patients with S. Pneumoniae isolates that were susceptible to penicillin | Prevalence not applicable Unadjusted OR 5.0 (1.9–13.3) Adjusted OR: 4.4 (1.6–7.0)g 4.9 (2.1–11.7)hgAdjusted for CD4+ count hAdjusted for previous hospitalization | CTX ↑ pneumococcal resistance to penicillin |
| Tumbarello et al 2002 [27] Italy case-control | HIV-infected patients aged >18 years with S. aureus bacteremia. Duration on CTX not given N=129 | Type 1 | Cases were HIV-positive patients with MRSA bacteremia and controls were defined as HIV-positive patients with MSSA bacteremia | Prevalence not applicable Unadjusted OR .76 (.36–1.60) Adjusted OR not given | CTX had no impact on MRSA |
| Achenbach et al 2006 [28] USA cross-sectional | HIV-positive adults, some on CTX and some not. Duration on CTX not given. N=85 | Type 2 | Prevalence of colonization with vancomycin resistant enterococcus | The only data presented is that colonization with resistant bacteria was associated with TMP-SMX prophylaxis, P=.05 | CTX ↑ resistance of enterococcus to penicillin |
| Cenizal et al 2008 [29] USA cross-sectional | HIV-positive adults, some on CTX and some not. Duration on CTX not given. N=146 | Type 2 | Prevalence of nasal colonization with MRSA | CTX=0/29 (0%) CNTL=15/102 (15%) P=.04 | CTX ↓ MRSA |
| Cotton et al 2008 [30] South Africa cross-sectional | HIV-positive children, some on CTX and some not. Duration on CTX not given. N=203 | Type 1 | Nasal colonization with S. Aureus | CTX: 87% CNTL: 70% P=.002 RR not reported | CTX ↑ MRSA |
| Pemba et al 2008 [33] South Africa cross-sectional | HIV-positive mine workers, some on CTX and some not. Duration on CTX not given. N=856 | Type 1 | Prevalence of penicillin resistant Pneumococcus among patients who were colonized | CTX=7/23 (30%) CNTL=4/49 (8%) Unadjusted RR 4.92 (1.27–19.7) Adjusted RR not given | CTX ↑ pneumococcal resistance to penicillin |
| Villacian et al 2004 [31] Singapore cross-sectional | HIV-positive adults, some on CTX and some not. Duration on CTX not given. N=195 | Type 2 | Prevalence of colonization with MRSA | Prevalence not reported Unadjusted RR 19.4 (1.2–347.4 Adjusted RR values not given, but after adjustment for confounders TMP-SMX was not associated with MRSA | CTX had no impact on MRSA |
| Zar et al 2003 [32] South Africa cross-sectional | HIV-positive children, some on TMP-SMX and some not. N=151 | Type 1 | Five different bacterial pathogens were cultured: K. Pneumonia; S.Aureus H. Influenza, S. Pneumonia, M.Catarrhalis. Prevalence of resistance of each organism to 3 or 4 different drugs was determined. | Data not presented in a way that allowed interpretation for this review: Of the pneumoccocal isolates from children taking prophylaxis, two were sensitive, three were intermediately resistant and one was resistant to penicillin. The single isolate from a child not on prophylaxis was penicillin-sensitive. | |
| Martin et al 1999 [34] USA before-after | Hospital patients. Antibiotic resistance levels were compared between the period during (n=19,514, 30,886 cultures) and one before (n not given, 24,884 cultures) widespread implementation of TMP-SMX prophylaxis. | Type 1 | Resistance of E.Coli and S. Aureas species among colonized or infected HIV-positive individuals were compared between two periods | CTX=72%; CNTL=41%l CTX=14%, CNTL=0% m CTX=21%; CNTL=0% n CTX=16%; CNTL=4% o CTX=14%; CNTL=0% p RR not reported l,mResistance of E. Coli to ampicillin and cephazolin respectively. n,o,pResistance of S. Aureas to ciprofloxacin, nafcillin and gentamicin respectively. In E. Coli and S. Aureas HIV-infected patients with CTX resistance were significantly more likely to display resistance to other antibiotics. | CTX ↑ Resistance of E. Coli and S. Aureus |
NOTE. CTX=Cotrimozaxole; CNTL=Control; MRSA=Methicillin Resistant Staphylococcus Aureas, MSSA=Methicillin Susceptible Staphylococcus Aureas, RR=Relative Risk, OR=Odds Ratio, MSM=Men having sex with men, CD4+=CD4+ T lymphocyte count.
a
The study was designed to look at the effect of TMP-SMX prophylaxis on resistance levels.
b
Clinically significant infection-Generally described in the specified papers as clinician diagnosis of infection as opposed to colonisation, and isolation of bacteria from a normally sterile body site.
c
1=Comparison group is based on having sensitive bacterial infection/colonisation; 2=comparison group is based on having no infection/colonisation at all.