Emergence of trimethoprim resistance in relation to drug consumption in a Finnish hospital from 1971 through 1984

Emergence of trimethoprim resistance among urinary tract Escherichia coli strains, isolated mostly from long-term patients in the Turku City Hospital, Turku, Finland, was studied from 1971 through 1984. Emergence of resistance to trimethoprim was associated with changes in the consumption of both trimethoprim-sulfamethoxazole and trimethoprim, with occurrence of high-level trimethoprim resistance and sequences homologous to trimethoprim resistance transposon Tn7. Since 1971, resistance of E. coli to trimethoprim-sulfamethoxazole increased from 8 to between 32 and 35% in 1983 and 1984; resistance to sulfamethoxazole varied from 39 to between 40 and 44%. The frequency of DNA sequence homology with our Tn7 probe among trimethoprim-resistant E. coli strains was 42% from 1980 to 1981 and 64% in 1983 (P less than 0.005). Fourteen years after the introduction of trimethoprim therapy in this hospital, resistance has reached the level of resistance to sulfonamide.