冰岛幽门螺杆菌的抗生素敏感性。

Antibiotic susceptibility of Helicobacter pylori in Iceland.

机构信息

a Hospital Pharmacy, Landspitali-The National University Hospital of Iceland , Reykjavik , Iceland.

b Faculty of Pharmaceutical sciences , The University of Iceland , Reykjavik , Iceland.

出版信息

Infect Dis (Lond). 2017 Sep;49(9):647-654. doi: 10.1080/23744235.2017.1317359. Epub 2017 Apr 25.

DOI:10.1080/23744235.2017.1317359

PMID:28440099

Abstract

BACKGROUND

Increasing resistance of Helicobacter pylori (H. pylori) to antibiotics calls for constant re-evaluation of multidrug regimens that have been used to eradicate the infection. The aim of this study was to evaluate the current antibiotic susceptibility of H. pylori in an Icelandic cohort.

METHODS

Patients referred for gastroscopy were recruited prospectively. Those found to have a positive rapid urease test were included in the study. Susceptibility testing was conducted by the Epsilometer test (E-test) method for ampicillin, clarithromycin, levofloxacin, metronidazole and tetracycline. Results were obtained after three days of incubation in microaerophilic conditions at 37 °C, except for the metronidazole were the first 24 hours were anaerobic.

RESULTS

Of the 613 patients who underwent gastroscopy, 138 (23%) had a positive rapid urease test. H. pylori was successfully cultured from 105 (76%) of the urease test positive patients and the isolates were tested for antibiotic susceptibility. Five patients had prior H. pylori eradication. Antibiotic resistance for ampicillin, clarithromycin, levofloxacin, metronidazole and tetracycline was 0%, 9%, 4%, 1% and 0%, respectively. If those who had previously undergone eradication treatment were excluded, the resistance was 0%, 6%, 3%, 1% and 0%, respectively. Clarithromycin resistance was higher amongst women than men, 13% vs. 5%, however, not significantly. Clarithromycin resistance was 60% amongst those who had previously received eradication treatment compared to 6% of those who had not (p < .0001).

CONCLUSIONS

Clarithromycin resistance amongst the H. pylori isolates can be considered relatively low. Therefore, in the current cohort, standard triple-drug clarithromycin-containing regimen should remain the first-line treatment against H. pylori.

摘要

背景

幽门螺杆菌（H. pylori）对抗生素的耐药性不断增加，需要不断重新评估用于根除感染的多药方案。本研究的目的是评估冰岛队列中 H. pylori 的当前抗生素敏感性。

方法

前瞻性招募接受胃镜检查的患者。那些快速尿素酶检测呈阳性的患者被纳入研究。通过 Epsilometer 测试（E-test）方法对氨苄西林、克拉霉素、左氧氟沙星、甲硝唑和四环素进行药敏试验。在 37°C 微需氧条件下孵育三天后获得结果，除甲硝唑外，前 24 小时为厌氧菌。

结果

在接受胃镜检查的 613 名患者中，有 138 名（23%）快速尿素酶检测呈阳性。从 105 名（76%）尿素酶检测阳性患者中成功培养出 H. pylori，并对其分离株进行了抗生素敏感性测试。有 5 名患者先前进行过 H. pylori 根除治疗。氨苄西林、克拉霉素、左氧氟沙星、甲硝唑和四环素的耐药率分别为 0%、9%、4%、1%和 0%。如果排除那些先前接受过根除治疗的患者，耐药率分别为 0%、6%、3%、1%和 0%。女性克拉霉素耐药率高于男性，分别为 13%和 5%，但无统计学意义。先前接受过根除治疗的患者中克拉霉素耐药率为 60%，而未接受过根除治疗的患者为 6%（p<0.0001）。