Department of Laboratory Medicine, Yongin Severance Hospital, Yongin, Korea.
Ann Lab Med. 2013 Nov;33(6):415-9. doi: 10.3343/alm.2013.33.6.415. Epub 2013 Oct 17.
Clarithromycin, amoxicillin, metronidazole, tetracycline, and levofloxacin have been commonly used for the eradication of Helicobacter pylori. We compared the change in antibiotic resistance of H. pylori strains during two separate periods and investigated the effect of antibiotic resistance on H. pylori eradication.
H. pylori strains were isolated from 71 patients between 2009 and 2010 and from 94 patients between 2011 and 2012. The distribution of minimal inhibitory concentration (MIC) of 5 antibiotics was assessed using the agar dilution method, and H. pylori eradication based on the antimicrobial susceptibility of the isolates was investigated retrospectively.
Antibiotic resistance rate against clarithromycin, amoxicillin, tetracycline, metronidazole, and levofloxacin for the 2009-2010 isolates were 7.0% (5/71), 2.8% (2/71), 0% (0/71), 45.1% (32/71), and 26.8% (19/71), respectively, and for the 2011-2012 isolates were 16.0% (15/94), 2.1% (2/94), 0% (0/94), 56.3% (53/94), and 22.3% (21/94), respectively. Multi-drug resistance for 2 or more antibiotics increased slightly from 16.9% (12/71) in the 2009-2010 isolates to 23.4% (22/94) in the 2011-2012 isolates. In follow-up testing of 66 patients, first-line treatment successfully eradicated H. pylori in 50 patients (75.8%) and failed in 4 of 7 patients (57.1%) in a clarithromycin-resistant and amoxicillin-susceptible group.
We observed an increase in resistance to clarithromycin and an overall increase in multi-drug resistance during the 2 study periods. The effectiveness of the eradication regimen was low with combinations of clarithromycin and amoxicillin, particularly in the clarithromycin-resistant group. Thus, eradication of H. pylori depends upon periodic monitoring of antimicrobial susceptibility.
克拉霉素、阿莫西林、甲硝唑、四环素和左氧氟沙星常用于根除幽门螺杆菌。我们比较了两个不同时期幽门螺杆菌菌株的抗生素耐药性变化，并研究了抗生素耐药性对幽门螺杆菌根除的影响。
从 2009 年至 2010 年的 71 名患者和 2011 年至 2012 年的 94 名患者中分离出幽门螺杆菌菌株。采用琼脂稀释法评估 5 种抗生素的最小抑菌浓度（MIC）分布，根据分离物的抗菌药敏性回顾性调查幽门螺杆菌根除情况。
2009-2010 年分离株对克拉霉素、阿莫西林、四环素、甲硝唑和左氧氟沙星的抗生素耐药率分别为 7.0%（5/71）、2.8%（2/71）、0%（0/71）、45.1%（32/71）和 26.8%（19/71），2011-2012 年分离株分别为 16.0%（15/94）、2.1%（2/94）、0%（0/94）、56.3%（53/94）和 22.3%（21/94）。2 种或 2 种以上抗生素的多药耐药性略有增加，从 2009-2010 年分离株的 16.9%（12/71）增加到 2011-2012 年分离株的 23.4%（22/94）。在对 66 名患者的随访检测中，克拉霉素耐药且阿莫西林敏感的 7 名患者中有 4 名（57.1%）治疗失败，而一线治疗成功根除幽门螺杆菌的患者有 50 名（75.8%）。
我们观察到在两个研究期间，对克拉霉素的耐药性增加，并且总体上多药耐药性增加。克拉霉素和阿莫西林联合用药的根除方案效果不佳，尤其是在克拉霉素耐药组。因此，幽门螺杆菌的根除取决于定期监测抗菌药物敏感性。
