Rojas Feria M, Suárez Barrenechea A I, Conejo Gonzalo C, Hergueta Delgado P, Romero Castro R, Herrerías Gutiérrez J M
Digestive System Service, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani, s/n. 41071 Sevilla.
Rev Esp Enferm Dig. 2000 Dec;92(12):793-8.
To determine the sensitivity to metronidazol, clarithromycin, amoxicillin and tetracycline of strains of Helicobacter pylori isolated in a prospective series of patients referred to a university hospital in Seville for endoscopic examination.
During the period from March 1998 to July 1999 we studied 117 patients with ulcer. The diagnosis of bacterial infection was based on the rapid urease test, histological study, Gram staining or culture of gastric biopsy material (from the antrum and corpus) obtained during gastroscopy. Susceptibility studies were done with the diffusion method using E-test strips.
Helicobacter pylori infection was found in 64 patients. A total of 58 strains were grown, 40 of which were from patients who had received no previous treatment to eradicate the infection (69%), and 18 of which were from patients who had failed one or more eradication therapies (31%). In the first group, metronidazol resistance was found in 42%, clarithromycin resistance in 13%, and resistance to both in 10% of the patients. In the second group these rates were 39%, 44% and 17% respectively, and one strain was found which was also resistant to tetracyclines (2%). No strains resistant to amoxicillin were found.
We found high rates of resistance, especially to clarithromycin, and especially in patients who had received previous eradication therapy. Empirical treatments should use effective antimicrobials and avoid regimens based on a single antibiotic. Culture of gastric biopsy samples provides information on the resistance to antimicrobials in a given setting, and this information can be used to develop the most rational treatment for the infection.
确定在塞维利亚一家大学医院接受内镜检查的前瞻性系列患者中分离出的幽门螺杆菌菌株对甲硝唑、克拉霉素、阿莫西林和四环素的敏感性。
在1998年3月至1999年7月期间，我们研究了117例溃疡患者。细菌感染的诊断基于快速尿素酶试验、组织学研究、革兰氏染色或胃镜检查时获取的胃活检材料（来自胃窦和胃体）培养。药敏研究采用E-test试纸条扩散法进行。
64例患者发现幽门螺杆菌感染。共培养出58株菌株，其中40株来自此前未接受过根除感染治疗的患者（69%），18株来自一种或多种根除治疗失败的患者（31%）。在第一组中，42%的患者发现对甲硝唑耐药，13%对克拉霉素耐药，10%对两者均耐药。在第二组中，这些比率分别为39%、44%和17%，发现一株对四环素也耐药（2%）。未发现对阿莫西林耐药的菌株。
我们发现耐药率很高，尤其是对克拉霉素，特别是在接受过先前根除治疗的患者中。经验性治疗应使用有效的抗菌药物，避免基于单一抗生素的治疗方案。胃活检样本培养可提供特定环境下对抗菌药物的耐药信息，该信息可用于制定最合理的感染治疗方案。
