Failure of Oral Trimethoprim-Sulfamethoxazole Prophylaxis in Acute Leukemia Isolation of Resistant Plasmids from Strains of Enterobacteriaceae Causing Bacteremia

Several recent studies of patients with granulocytopenia have shown that the prophylactic administration of oral trimethoprim–sulfamethoxazole (TMP-SMX) is effective in preventing sepsis with Enterobacteriaceae. 1 2 3 4 5 However, we have recently seen two patients with acute leukemia and granulocyt...

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Bibliographic Details
Published inThe New England journal of medicine Vol. 306; no. 1; pp. 16 - 20
Main Authors Wilson, Jack M, Guiney, Donald G
Format Journal Article
LanguageEnglish
Published United States Massachusetts Medical Society 07.01.1982
Subjects
Acute Disease
Adult
Agranulocytosis - complications
Anti-Bacterial Agents - pharmacology
Antibiotics
Case reports
Cell culture
Chemotherapy
Deoxyribonucleic acid
DNA
Drug resistance
Drug Resistance, Microbial
E coli
Enterobacteriaceae
Enterobacteriaceae - drug effects
Enterobacteriaceae Infections - prevention & control
Enzymes
Escherichia coli
Granulocytes
Humans
Infectious diseases
Klebsiella pneumoniae
Leukemia
Leukemia - complications
Male
Molecular weight
Patients
Plasmids
Plasmids - drug effects
Prophylaxis
Sepsis
Sepsis - prevention & control
Sulfamethoxazole
Sulfamethoxazole - administration & dosage
Sulfamethoxazole - pharmacology
Trimethoprim
Trimethoprim - administration & dosage
Trimethoprim - pharmacology
Trimethoprim-sulfamethoxazole
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Summary:Several recent studies of patients with granulocytopenia have shown that the prophylactic administration of oral trimethoprim–sulfamethoxazole (TMP-SMX) is effective in preventing sepsis with Enterobacteriaceae. 1 2 3 4 5 However, we have recently seen two patients with acute leukemia and granulocytopenia who received oral TMP-SMX prophylaxis but subsequently had sepsis with Enterobacteriaceae that were resistant to TMP-SMX. In one patient, a transferable plasmid encoding resistance to trimethoprim and sulfonamide was isolated from two different bacterial species. In the other patient, a transferable sulfonamide-resistance plasmid was found together with chromosomally mediated trimethoprim resistance in a single strain. Methods Patients and Bacterial Strains The TMP-SMX-resistant strains were . . .
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ISSN:0028-4793
1533-4406
DOI:10.1056/NEJM198201073060105