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JAC Advance Access published online on May 10, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki151
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Received January 17, 2005
Revised March 22, 2005
Accepted April 8, 2005

Brief report

Trimethoprim/sulfamethoxazole resistance in clinical isolates of Burkholderia pseudomallei

Vanaporn Wuthiekanun 1, Allen C. Cheng 2, Wirongrong Chierakul 1, Premjit Amornchai 1, Direk Limmathurotsakul 1, Wipada Chaowagul 3, Andrew J. H. Simpson 4, Jennifer M. Short 5, Gumphol Wongsuvan 1, Bina Maharjan 1, Nicholas J. White 6, and Sharon J. Peacock 7*

1 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
2 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Menzies School of Health Research, Charles Darwin University and Northern Territory Clinical School, Flinders University, Darwin, Australia
3 Medical Department, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand
4 Biomedical Sciences, DSTL, Salisbury;, UK
5 Department of Infection and Tropical Medicine, Heartlands Hospital, Birmingham;, UK
6 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, UK
7 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, UK

* To whom correspondence should be addressed.
Sharon J. Peacock, E-mail: sharon{at}tropmedres.ac


  Abstract

Objectives: Trimethoprim/sulfamethoxazole is commonly used to treat melioidosis. Antimicrobial susceptibility testing using the disc diffusion method is commonly used in melioidosis-endemic areas, but may overestimate resistance to trimethoprim/sulfamethoxazole.

Patients and methods: We performed disc diffusion and Etest on isolates from the first positive culture for all patients presenting to Sappasithiprasong Hospital, Ubon Ratchathani, Thailand, with culture-confirmed melioidosis between 1992 and 2003.

Results: The estimated resistance rate for 1976 clinical Burkholderia pseudomallei isolates was 13% by Etest and 71% by disc diffusion. All isolates classed as either susceptible (n=358) or as having intermediate resistance (n=218) on disc diffusion were susceptible by Etest. Only 258 of the 1400 (18%) isolates classed as resistant on disc diffusion were resistant by Etest.

Conclusions: Disc diffusion testing of B. pseudomallei may be useful as a limited screening tool in resource poor settings. Isolates assigned as ‘susceptible’ or ‘intermediate’ by disc diffusion may be viewed as ‘susceptible’; those assigned as ‘resistant’ require further evaluation by MIC methodology.

Keywords: Burkholderia pseudomallei; melioidosis; susceptibility; Etest.
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