Chisholm Stephanie A, Owen Robert J
Gastrointestinal, Emerging and Zoonotic Infections Department, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5HT, UK.
J Med Microbiol. 2009 Oct;58(Pt 10):1322-1328. doi: 10.1099/jmm.0.011270-0. Epub 2009 Jul 9.
Treatment failure with standard Helicobacter pylori eradication regimes may require the use of 'rescue' therapies containing fluoroquinolones or rifamycins. The susceptibilities of H. pylori in the UK to such antimicrobials are unknown; therefore, this study aimed to determine the frequencies and molecular markers of resistance. Ciprofloxacin and rifampicin susceptibilities were determined by Etest and/or disc diffusion for 255 isolates of H. pylori, including 171 isolates from adult dyspeptic patients with refractive infections. Mutations in known resistance-determining regions of gyrA and rpoB were determined. The ciprofloxacin resistance rate was 7.5 %, and gyrA mutations, predominantly at codon position 91, were identified in most resistant isolates. One isolate (<1 %) had an unequivocal rifampicin-resistant phenotype by Etest yet had no associated mutations in the rpoB gene. As resistance rates were low in H. pylori isolates, including those from patients with refractive infections, it was concluded that fluoroquinolones or rifamycins might be considered in the UK for inclusion in 'rescue' therapies.
标准的幽门螺杆菌根除方案治疗失败可能需要使用含氟喹诺酮类或利福霉素的“挽救”疗法。英国幽门螺杆菌对这类抗菌药物的敏感性未知；因此，本研究旨在确定耐药的频率和分子标记。采用Etest法和/或纸片扩散法测定了255株幽门螺杆菌对环丙沙星和利福平的敏感性，其中包括171株来自患有难治性感染的成人消化不良患者的菌株。测定了gyrA和rpoB已知耐药决定区域的突变情况。环丙沙星耐药率为7.5%，在大多数耐药菌株中鉴定出主要位于第91位密码子的gyrA突变。1株菌株（<1%）通过Etest法显示明确的利福平耐药表型，但rpoB基因无相关突变。由于幽门螺杆菌分离株，包括来自难治性感染患者的分离株的耐药率较低，得出结论认为在英国氟喹诺酮类或利福霉素可考虑纳入“挽救”疗法。
