Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Helicobacter. 2017 Dec;22(6). doi: 10.1111/hel.12440. Epub 2017 Sep 15.
The rate of H. pylori resistance to different antibiotics is increasing and determines the selection of eradication therapy. The aim of this study was to determine the resistance patterns of H. pylori strains in our area.
Biopsies from gastric corpus for microbiological culture and antibiotic resistance were obtained in patients undergoing upper gastrointestinal endoscopy for dyspepsia. Selective Agar Pylori for isolation of the bacteria and Agar Mueller-Hinton supplemented with blood to test the sensitivity to antibiotics were used. Presence of H. pylori was confirmed using direct observation with phase-contrast microscopy and/or smears stained with acridine orange. In vitro bacterial susceptibility to amoxicillin, clarithromycin, rifampicin, tetracycline, metronidazole, and levofloxacin was tested using diffusion MIC test strips. Minimum inhibitory concentration values were determined based on the 6th version of the EUCAST (European Committee on Antimicrobial Susceptibility Testing) Clinical Breakpoint (2016).
Two hundred and seventeen patients were included (58.1% female, median age 64 years, range 25-92). H. pylori was identified in 108 patients (49.8%); culture and antibiogram were completed in 77 of them (71.3% of H. pylori-positive patients). The resistance rates were as follows: levofloxacin 38.7%, rifampicin 33.3%, metronidazole 27% and clarithromycin 22.4%. No case of amoxicillin or tetracycline resistance was identified. Dual clarithromycin-metronidazole resistance was observed in 10% of strains, whereas multiple drug-resistant was observed in 14.2%.
Resistance rate of H. pylori to antibiotics is high in the northwest of Spain. The high resistance to levofloxacin and clarithromycin advises against their wide empirical use of these antibiotics in eradication regimens.
不同抗生素的幽门螺杆菌耐药率不断上升，这决定了根除治疗的选择。本研究旨在确定本地区幽门螺杆菌菌株的耐药模式。
对因消化不良行上消化道内镜检查的患者进行胃体活检，以获取用于微生物培养和抗生素耐药性检测的标本。采用选择性琼脂幽门螺杆菌分离细菌，并用含血的琼脂 Mueller-Hinton 检测抗生素敏感性。通过相差显微镜直接观察或用吖啶橙染色的涂片来确认幽门螺杆菌的存在。采用扩散 MIC 测试条检测阿莫西林、克拉霉素、利福平、四环素、甲硝唑和左氧氟沙星的体外细菌药敏性。根据欧盟药敏试验委员会（European Committee on Antimicrobial Susceptibility Testing）第 6 版临床折点（2016 年）确定最小抑菌浓度值。
共纳入 217 例患者（女性占 58.1%，中位年龄 64 岁，范围 25-92 岁）。108 例（49.8%）患者检出幽门螺杆菌；其中 77 例（阳性患者的 71.3%）完成了培养和药敏试验。耐药率如下：左氧氟沙星 38.7%、利福平 33.3%、甲硝唑 27%和克拉霉素 22.4%。未发现阿莫西林或四环素耐药病例。10%的菌株存在克拉霉素-甲硝唑双重耐药，14.2%的菌株存在多药耐药。
西班牙西北部的幽门螺杆菌对抗生素的耐药率较高。左氧氟沙星和克拉霉素的高耐药率表明，在根除方案中不应广泛经验性使用这些抗生素。
