Evidence for an Epidemic Trimethoprim-Resistance Plasmid in Fecal Isolates of Escherichia coli from Citizens of the United States Studying in Mexico

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Abstract
A previous study revealed the emergence of high-level resistance to trimethoprim-sulfamethoxazole in strains of Escherichia coli isolated from 95% of students from the United States who were taking either trimethoprim alone or trimethoprim-sulfamethoxazole for prophylaxis of travelers' diarrhea while in Guadalajara, Mexico. Many of these strains were subsequently demonstrated to cotransfer resistance to trimethoprim along with that to streptomycin and ampicillin. The present study demonstrated that at least 12 (60%) of 20 transferable (tra+) trimethoprim-resistance plasmids studied possessed both an identical Hind III restriction pattern and type I dihydrofolate reductase genes. Donor strains were shown to be distinct; this finding suggested that a common tra+ trimethoprim-resistance plasmid was widely disseminated among E. coli strains in Guadalajara. These results may explain in part the surprising degree of resistance encountered in trimethoprim-consuming persons in that region.