a From the Department of Medical Microbiology , Medical University of Sofia , Sofia , Bulgaria.
b Department of Gastroenterology , University Hospital St Ekaterina , Sofia , Bulgaria.
Infect Dis (Lond). 2016;48(1):56-62. doi: 10.3109/23744235.2015.1082035.
Helicobacter pylori resistance to antibiotics is the main cause for eradication failures.
Antibiotic resistance in 299 H. pylori strains from 233 untreated adults, 26 treated adults, and 40 untreated children was assessed by E tests and, for metronidazole, by breakpoint susceptibility testing and two breakpoint systems.
Using EUCAST breakpoints (EBPs) and previous breakpoints (PBPs), overall resistance rates were: amoxicillin 4.0 and 0.6%, metronidazole 33.8 and 33.8%, clarithromycin 28.1 and 27.4%, levofloxacin 19.4 and 19.4%, tetracycline 3.7 and 1.5%, respectively, and rifampin 8.3% (EBP). Multidrug resistance was detected in treated and untreated adults and an untreated child and included 17 (EBPs) and 15 strains (PBPs). Differences between susceptibility categories were found for amoxicillin (3.5% of strains), clarithromycin (0.7%), and tetracycline (2.2%). Using PBPs, from 2005-2007 to 2010-2015, overall primary clarithromycin resistance continued to increase (17.9-25.6%) as noted in our previous study. However, in 2010-2015, overall primary metronidazole (24.0-31.5%) and fluoroquinolone (7.6-18.3%) resistance rates also increased. Primary resistance rates in children and adults were comparable.
Briefly, differences in resistance rates by the two breakpoint systems affected the results for three antibiotics. National antibiotic consumption was linked to macrolide resistance in adults. Current primary H. pylori resistance to three antibiotics increased in all untreated patients and in the untreated adults, with the sharpest rise for the fluoroquinolones. The presence of fivefold H. pylori resistance to metronidazole, clarithromycin, tetracycline, levofloxacin, and amoxicillin according to EBPs is alarming.
幽门螺杆菌对抗生素的耐药性是根除失败的主要原因。
通过 E 试验和甲硝唑的药敏试验以及两种断点系统，评估了来自 233 名未经治疗的成年人、26 名经治疗的成年人和 40 名未经治疗的儿童的 299 株幽门螺杆菌菌株的抗生素耐药性。
使用 EUCAST 断点（EBPs）和以前的断点（PBPs），总的耐药率分别为：阿莫西林 4.0%和 0.6%、甲硝唑 33.8%和 33.8%、克拉霉素 28.1%和 27.4%、左氧氟沙星 19.4%和 19.4%、四环素 3.7%和 1.5%，利福平 8.3%（EBP）。在未经治疗的成年人和儿童中发现了多药耐药性，包括 17 株（EBP）和 15 株（PBP）。在阿莫西林（3.5%的菌株）、克拉霉素（0.7%）和四环素（2.2%）中发现了药敏类别之间的差异。使用 PBPs，从 2005-2007 年到 2010-2015 年，正如我们之前的研究所示，大环内酯类药物的总体原发性耐药性继续增加（17.9-25.6%）。然而，在 2010-2015 年，总体原发性甲硝唑（24.0-31.5%）和氟喹诺酮（7.6-18.3%）耐药率也有所增加。儿童和成人的原发性耐药率相当。
简要地说，两种断点系统的耐药率差异影响了三种抗生素的结果。国家抗生素消费与成人大环内酯类耐药性有关。所有未经治疗的患者和未经治疗的成年人中，目前三种抗生素对幽门螺杆菌的原发性耐药性均有所增加，其中氟喹诺酮类的上升幅度最大。根据 EBPs，五种倍剂量的甲硝唑、克拉霉素、四环素、左氧氟沙星和阿莫西林对幽门螺杆菌的耐药性令人震惊。
