Shokrzadeh Leila, Alebouyeh Masoud, Mirzaei Tabassom, Farzi Nastaran, Zali Mohammad Reza
1 Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran .
Microb Drug Resist. 2015 Feb;21(1):105-10. doi: 10.1089/mdr.2014.0081. Epub 2014 Oct 10.
Emergence of multidrug-resistant (MDR) strains of Helicobacter pylori is a global health concern. This study was aimed to determine the frequency of MDR H. pylori strains in Iran. H. pylori isolates were obtained from cultured gastric biopsy samples on selective culture media after their characterization by PCR and conventional biochemical methods. The minimal inhibitory concentrations of rifampicin, ciprofloxacin, levofloxacin, ampicillin, clarithromycin, erythromycin, metronidazole, and tetracycline were determined for 111 strains that were isolated from 197 dyspeptic patients by the agar dilution method. The primary resistance rates were 61.3% (68/111) for metronidazole, 15.3% (17/111) for ampicillin, and 14.4% (16/111) for rifampicin. Resistance rates for other antimicrobials were as follows: macrolides (erythromycin or clarithromycin) 32.4% (36/111) and quinolones (levofloxacin or ciprofloxacin) 30.6% (34/111). Among the resistant strains, the rates of double and multiple drug resistance phenotypes were 22.6% (19/84) and 34.5% (29/84), respectively. The quadruple drug resistance phenotype encompasses 37.9% of the MDR strains, of which 90% of them was resistant to metronidazole. In conclusion, these results showed a high frequency of MDR phenotypes among the studied H. pylori strains in Iran. The eradication of the H. pylori strains presenting high resistance rates to macrolides, fluoroquinolones, or metronidazole could be achieved by approved tetracycline- or amoxicillin-containing regimens as alternative regimens to standard triple therapy.
幽门螺杆菌多重耐药（MDR）菌株的出现是一个全球健康问题。本研究旨在确定伊朗MDR幽门螺杆菌菌株的频率。通过PCR和传统生化方法对幽门螺杆菌进行鉴定后，从选择性培养基上培养的胃活检样本中获取幽门螺杆菌分离株。采用琼脂稀释法测定了从197例消化不良患者中分离出的111株菌株对利福平、环丙沙星、左氧氟沙星、氨苄西林、克拉霉素、红霉素、甲硝唑和四环素的最低抑菌浓度。甲硝唑的初始耐药率为61.3%（68/111），氨苄西林为15.3%（17/111），利福平为14.4%（16/111）。其他抗菌药物的耐药率如下：大环内酯类（红霉素或克拉霉素）32.4%（36/111），喹诺酮类（左氧氟沙星或环丙沙星）30.6%（34/111）。在耐药菌株中，双重和多重耐药表型的发生率分别为22.6%（19/84）和34.5%（29/84）。四重耐药表型占MDR菌株的37.9%，其中90%对甲硝唑耐药。总之，这些结果表明在伊朗所研究的幽门螺杆菌菌株中MDR表型的频率很高。对于对大环内酯类、氟喹诺酮类或甲硝唑呈现高耐药率的幽门螺杆菌菌株，可通过批准的含四环素或阿莫西林的方案作为标准三联疗法的替代方案来实现根除。
