Rozynek Elzbieta, Dzierzanowska-Fangrat Katarzyna, Celińska-Cedro Danuta, Jóźwiak Paulina, Madaliński Kazimierz, Dzierzanowska Danuta
Department of Clinical Microbiology and Immunology, Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-736 Warsaw, Poland.
Acta Microbiol Pol. 2002;51(3):255-63.
Helicobacter pylori resistance to antimicrobial agents is an important factor compromising the efficacy of treatment. Therefore the aims of our study were: to determine the prevalence of H. pylori resistance to clarithromycin, metronidazole, amoxycillin and tetracycline in children prior to eradication therapy, to compare different methods of susceptibility testing and to detect mutations responsible for clarithromycin resistance. During 1996-2000, 259 H. pylori strains were isolated from antral gastric biopsies. Susceptibility to antimicrobials was determined by the agar dilution method and the Etest. Mutations in the 23S rRNA gene associated with clarithromycin resistance were analysed by PCR-RFLP and direct sequencing. Overall, ninety-six strains (37%) were resistant to metronidazole, 50 strains (19.3%) were resistant to clarithromycin, and 20 strains (7.7%) were simultaneously resistant to both drugs. All cultured isolates were sensitive to amoxycillin and only one isolate (0.4%) was resistant to tetracycline. The agar dilution method and the Etest showed a perfect category correlation for clarithromycin and 4% discrepancies for metronidazole. Primary resistance to clarithromycin was mainly associated with an A2143G mutation in the 23S rRNA gene of H. pylori. The study highlights the high prevalence of H. pylori primary resistance to clarithromycin in Polish children, which implies a need for pretreatment susceptibility testing.
幽门螺杆菌对抗菌药物的耐药性是影响治疗效果的一个重要因素。因此，我们研究的目的是：确定根除治疗前儿童幽门螺杆菌对克拉霉素、甲硝唑、阿莫西林和四环素的耐药率，比较不同的药敏试验方法，并检测导致克拉霉素耐药的突变。在1996年至2000年期间，从胃窦活检中分离出259株幽门螺杆菌菌株。采用琼脂稀释法和Etest法测定抗菌药物敏感性。通过PCR-RFLP和直接测序分析与克拉霉素耐药相关的23S rRNA基因中的突变。总体而言，96株（37%）对甲硝唑耐药，50株（19.3%）对克拉霉素耐药，20株（7.7%）同时对两种药物耐药。所有培养的分离株对阿莫西林敏感，只有1株（0.4%）对四环素耐药。琼脂稀释法和Etest法对克拉霉素显示出完美的类别相关性，对甲硝唑的差异为4%。克拉霉素的原发性耐药主要与幽门螺杆菌23S rRNA基因中的A2143G突变有关。该研究强调了波兰儿童幽门螺杆菌对克拉霉素原发性耐药的高发生率，这意味着需要进行治疗前药敏试验。
