Ogata Silvio Kazuo, Gales Ana Cristina, Kawakami Elisabete
Disciplina de Gastroenterologia Pediátrica Hepatologica e Nutrição Escola Paulista de Medicina Universidade Federal de São Paulo São PauloSP Brazil Disciplina de Gastroenterologia Pediátrica, Hepatologica e Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Laboratório Especial de Microbiologia Clínica Departamento de Doenças Infecciosas Escola Paulista de Medicina Universidade Federal de São Paulo São PauloSP Brazil Laboratório Especial de Microbiologia Clínica, Departamento de Doenças Infecciosas, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Braz J Microbiol. 2015 Mar 4;45(4):1439-48. doi: 10.1590/s1517-83822014000400039. eCollection 2014.
Antimicrobial susceptibility testing for Helicobacter pylori is increasingly important due to resistance to the most used antimicrobials agents. Only agar dilution method is approved by CLSI, but it is difficult to perform routinely. We evaluated the reliability of E-test and disk diffusion comparing to agar dilution method on Helicobacter pylori antimicrobial susceptibility testing. Susceptibility testing was performed for amoxicillin, clarithromycin, furazolidone, metronidazole and tetracycline using E-test, disk-diffusion and agar dilution method in 77 consecutive Helicobacter pylori strains from dyspeptic children and adolescents. Resistance rates were: amoxicillin - 10.4%, 9% and 68.8%; clarithromycin - 19.5%, 20.8%, 36.3%; metronidazole - 40.2%33.7%, 38.9%, respectively by agar dilution, E-test and disk diffusion method. Furazolidone and tetracycline showed no resistance rates. Metronidazole presented strong correlation to E-test (r = 0.7992, p < 0.0001) and disk diffusion method (r=-0.6962, p < 0.0001). Clarithromycin presented moderate correlation to E-test (r = 0.6369, p < 0.0001) and disk diffusion method (r=-0.5656, p < 0.0001). Amoxicillin presented weak correlation to E-test (r = 0.3565, p = 0.0015) and disk diffusion (r=-0.3565, p = 0.0015). Tetracycline presented weak correlation with E-test (r = 0.2346, p = 0.04) and furazolidone to disk diffusion (r=-0.0288, p = 0.8038). E-test presented better agreement with gold standard. It is an easy and reliable method for Helicobacter pylori susceptibility testing. Disk diffusion method presented high disagreement and high rates of major errors.
由于幽门螺杆菌对最常用抗菌药物产生耐药性，其药敏试验变得越来越重要。只有琼脂稀释法得到了美国临床和实验室标准协会（CLSI）的认可，但常规操作起来很困难。我们评估了E-test法和纸片扩散法相对于琼脂稀释法在幽门螺杆菌药敏试验中的可靠性。采用E-test法、纸片扩散法和琼脂稀释法，对77株来自消化不良儿童和青少年的连续幽门螺杆菌菌株进行了阿莫西林、克拉霉素、呋喃唑酮、甲硝唑和四环素的药敏试验。耐药率分别为：琼脂稀释法检测阿莫西林为10.4%，E-test法为9%，纸片扩散法为68.8%；克拉霉素分别为36.3%、19.5%、20.8%；甲硝唑分别为38.9%、40.2%、33.7%。呋喃唑酮和四环素未显示耐药率。甲硝唑与E-test法（r = 0.7992，p < 0.0001）和纸片扩散法（r = -0.6962，p < 0.0001）呈现强相关性。克拉霉素与E-test法（r = 0.6369，p < 0.
