Ahmed Dilruba, Brooks Heather, McConnell Michelle, Barbezat Gil
Department of Microbiology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
N Z Med J. 2004 Aug 20;117(1200):U1022.
Infection with Helicobacter pylori requires antibiotic treatment when associated with upper gastrointestinal symptoms. Antibiotic susceptibility tests on this pathogen are rarely carried out and there is little information available on the incidence of antibiotic resistant strains in New Zealand. The aim of this study was to assess the susceptibility of H. pylori (cultured from gastric biopsies in Dunedin) to antibiotics that are commonly used in treatment.
Over a 13-month period, gastric biopsies were obtained from selected patients undergoing endoscopy at Dunedin Public Hospital because of upper gastrointestinal symptoms. Biopsies were cultured for H. pylori and examined histologically. Fifty isolates from 50 patients with histological findings compatible with H. pylori infection were tested for sensitivity to metronidazole, clarithromycin, amoxycillin, and tetracycline using the epsilometer (E-) test.
Metronidazole resistance was detected in 10 (20%) isolates. These isolates were highly resistant to metronidazole and were not inhibited by 250 mg/L. Resistance to clarithromycin, amoxycillin, and doxycycline was not detected.
Clinicians should be aware that resistance to metronidazole appears to be common in H. pylori in New Zealand and that treatment regimens including this antibiotic may be less effective as a result. Although clarithromycin resistance was not detected, it is becoming increasingly problematical overseas and has been recorded in Auckland.
幽门螺杆菌感染若伴有上消化道症状则需要进行抗生素治疗。针对这种病原体的抗生素敏感性测试很少开展，并且关于新西兰抗生素耐药菌株的发生率几乎没有相关信息。本研究的目的是评估幽门螺杆菌（从但尼丁的胃活检组织中培养获得）对常用治疗抗生素的敏感性。
在13个月的时间里，从因上消化道症状在但尼丁公立医院接受内镜检查的选定患者中获取胃活检组织。对活检组织进行幽门螺杆菌培养并进行组织学检查。使用埃普利米特（E-）试验对50例组织学检查结果与幽门螺杆菌感染相符的患者的50株分离菌株进行甲硝唑、克拉霉素、阿莫西林和四环素的敏感性测试。
在10株（20%）分离菌株中检测到甲硝唑耐药。这些分离菌株对甲硝唑高度耐药，在250mg/L浓度下未被抑制。未检测到对克拉霉素、阿莫西林和强力霉素的耐药。
临床医生应意识到，在新西兰幽门螺杆菌对甲硝唑的耐药似乎很常见，因此包含这种抗生素的治疗方案可能效果较差。尽管未检测到克拉霉素耐药，但在海外其问题日益严重，并且在奥克兰已有记录。
