Rajper Sana, Khan Erum, Ahmad Zubair, Alam Syed Muhammad Zaheer, Akbar Adil, Hasan Rumina
Department of Pathology Microbiology, Aga Khan University Hospital, Karachi, Pakistan.
J Pak Med Assoc. 2012 Nov;62(11):1140-4.
To assess fluoroquinolone and clarithromycin susceptibility pattern along with the types of genomic mutations involved in the resistance of Helicobacter pylori isolates.
The cross-sectional study was conducted at the Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, from June 2009 to July 2010, and comprised 162 gastric biopsy samples which were tested with GenoTypeHelicoDR (Hain Lifescience GmbH, Germany), a reverse hybridisation multiplex polymerase chain reaction (PCR) line probe assay (LiPA). Also, 23S rRNA (ribosomal ribonucleic acid) gene was analysed with three-point mutations at A2146G, A2146C and A2147G for clarithromycin, and gyrA gene was analyzed at two codon positions 87 and 91 for fluoroquinolone susceptibility testing. SPSS 19 was used for statistical analyses.
Clarithromycin resistance was seen in 60 (37.0%) of the isolates mainly involving mutation at A2147G (85%) followed by A2146G (n=35; 21.6%) and A2146C (n=19; 11.6%). Fluoroquinolone resistance was noted in 101(62.3%) isolates, while gyrA mutations at codon 87 was seen in 64 (39.6%) and at codon 91 in 66 (40.6%). Isolates showing combined resistance to both antibiotics were 44 (26.9%).
High rate of resistance to fluoroquinolones was seen despite the fact that the drug was not part of the first-line anti-helicobacter therapy. There was moderate increase of clarithromycin resistance beyond the cutoff rates where empirical use of this antibiotic is abandoned. The findings warrant the need for pre-treatment susceptibility testing in Helicobacter pylori infections, especially in Pakistan where burden of disease is high and very limited data is available, to improve patient care by providing targeted therapy.
评估幽门螺杆菌分离株对氟喹诺酮类和克拉霉素的药敏模式以及耐药相关的基因突变类型。
2009年6月至2010年7月在卡拉奇阿迦汗大学医院病理与微生物学系进行了一项横断面研究，纳入162份胃活检样本，采用GenoTypeHelicoDR（德国海因生命科学有限公司）进行检测，这是一种反向杂交多重聚合酶链反应（PCR）线性探针分析（LiPA）。此外，分析23S核糖体核糖核酸（rRNA）基因A2146G、A2146C和A2147G位点的三点突变以检测克拉霉素耐药情况，分析gyrA基因87和91两个密码子位置以检测氟喹诺酮类药敏情况。使用SPSS 19进行统计分析。
60株（37.0%）分离株对克拉霉素耐药，主要涉及A2147G位点突变（85%），其次是A2146G（n = 35；21.6%）和A21,46C（n = 19；11.6%）。101株（62.3%）分离株对氟喹诺酮类耐药，其中64株（39.6%）在87密码子位置有gyrA突变，66株（40.6%）在91密码子位置有gyrA突变。对两种抗生素均耐药的分离株有44株（26.9%）。
尽管氟喹诺酮类药物并非一线抗幽门螺杆菌治疗药物，但对其耐药率仍较高。克拉霉素耐药率在经验性使用该抗生素被放弃的临界值之上有适度上升。这些发现表明在幽门螺杆菌感染中需要进行治疗前药敏检测，尤其是在疾病负担高且可用数据非常有限的巴基斯坦，通过提供针对性治疗来改善患者护理。
