印度患者幽门螺杆菌临床分离株抗菌药物耐药模式的地理差异：多中心研究。
Geographical difference in antimicrobial resistance pattern of Helicobacter pylori clinical isolates from Indian patients: Multicentric study.
作者信息
Thyagarajan S P, Ray Pallab, Das Bimal Kumar, Ayyagari Archana, Khan Aleem Ahmed, Dharmalingam S, Rao Usha Anand, Rajasambandam P, Ramathilagam B, Bhasin Deepak, Sharma M P, Naik S R, Habibullah C M
机构信息
Departments of Microbiology and Gastroenterology, Dr ALM Post Graduate Institute of Basic Medical Sciences and Government General Hospital, Chennai, India.
出版信息
J Gastroenterol Hepatol. 2003 Dec;18(12):1373-8. doi: 10.1046/j.1440-1746.2003.03174.x.
AIM
To assess the pattern of antimicrobial resistance of Helicobacter pylori isolates from peptic ulcer disease patients of Chandigarh, Delhi, Lucknow, Hyderabad and Chennai in India, and to recommend an updated anti-H. pylori treatment regimen to be used in these areas.
METHODS
Two hundred and fifty-nine H. pylori isolates from patients with peptic ulcer disease reporting for clinical management to the Post Graduate Institute of Medical Education and Research, Chandigarh; All India Institute of Medical Sciences, New Delhi; Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow; Deccan College of Medical Sciences and Allied Hospitals, Hyderabad; and hospitals in Chennai in collaboration with the Dr ALM Post Graduate Institute of Basic Medical Sciences were analyzed for their levels of antibiotic susceptibility to metronidazole, clarithromycin, amoxycillin, ciprofloxacin and tetracycline. The Epsilometer test (E-test), a quantitative disc diffusion antibiotic susceptibility testing method, was adopted in all the centers. The pattern of single and multiple resistance at the respective centers and at the national level were analyzed.
RESULTS
Overall H. pylori resistance rate was 77.9% to metronidazole, 44.7% to clarithromycin and 32.8% to amoxycillin. Multiple resistance was seen in 112/259 isolates (43.2%) and these were two/three and four drug resistance pattern to metronidazole, clarithromycin, amoxycillin observed (13.2, 32 and 2.56%, respectively). Metronidazole resistance was high in Lucknow, Chennai and Hyderabad (68, 88.2 and 100%, respectively) and moderate in Delhi (37.5%) and Chandigarh (38.2%). Ciprofloxacin and tetracycline resistance was the least, ranging from 1.0 to 4%.
CONCLUSION
In the Indian population, the prevalence of resistance of H. pylori is very high to metronidazole, moderate to clarithromycin and amoxycillin and low to ciprofloxacin and tetracycline. The rate of resistance was higher in southern India than in northern India. The E-test emerges as a reliable quantitative antibiotic susceptibility test. A change in antibiotic policy to provide scope for rotation of antibiotics in the treatment of H. pylori in India is a public health emergency.
目的
评估印度昌迪加尔、德里、勒克瑙、海得拉巴和金奈消化性溃疡病患者幽门螺杆菌分离株的耐药模式，并推荐适用于这些地区的更新抗幽门螺杆菌治疗方案。
方法
分析了259株来自消化性溃疡病患者的幽门螺杆菌分离株，这些患者前往昌迪加尔医学教育与研究研究生院、新德里全印度医学科学研究所、勒克瑙桑贾伊·甘地医学科学研究生院、海得拉巴德ccan医学院及附属医院以及金奈的医院就医，并与ALM基础医学科学研究生学院合作，检测其对甲硝唑、克拉霉素、阿莫西林、环丙沙星和四环素的抗生素敏感性水平。所有中心均采用Epsilometer试验（E试验），这是一种定量纸片扩散法抗生素敏感性试验方法。分析了各中心及全国范围内的单药耐药和多药耐药模式。
结果
幽门螺杆菌对甲硝唑的总体耐药率为77.9%，对克拉霉素为44.7%，对阿莫西林为32.8%。112/259株分离株（43.2%）出现多药耐药，观察到对甲硝唑、克拉霉素、阿莫西林的双药/三药和四药耐药模式（分别为13.2%、32%和2.56%）。勒克瑙、金奈和海得拉巴的甲硝唑耐药率较高（分别为68%、88.2%和100%），德里（37.5%）和昌迪加尔（38.2%）的耐药率中等。环丙沙星和四环素的耐药率最低，为1.0%至4%。
结论
在印度人群中，幽门螺杆菌对甲硝唑的耐药率很高，对克拉霉素和阿莫西林的耐药率中等，对环丙沙星和四环素的耐药率较低。印度南部的耐药率高于北部。E试验是一种可靠的定量抗生素敏感性试验。在印度，改变抗生素政策以便为幽门螺杆菌治疗中抗生素轮换提供空间是一项公共卫生紧急情况。
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