Mori Hideki, Suzuki Hidekazu, Matsuzaki Juntaro, Masaoka Tatsuhiro, Kanai Takanori
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
United European Gastroenterol J. 2018 Apr;6(3):391-397. doi: 10.1177/2050640617737215. Epub 2017 Oct 8.
Although sitafloxacin (STFX)-containing regimens are effective rescue treatments for infection, prevalence of fluoroquinolone resistance in has increased rapidly worldwide. The change in resistance levels and mutations, a major cause of fluoroquinolone resistance, after unsuccessful STFX-containing treatment has not been investigated.
We conducted a retrospective, non-randomized study to compare the minimum inhibitory concentrations (MICs) of STFX and the location of mutations in before and after unsuccessful eradication with STFX-containing regimens at Keio University Hospital between December 2011 and March 2015.
A total of 266 patients treated with STFX-containing regimens for third-line eradication were evaluated. Double mutations in were acquired by 20.8% of strains that exhibited seven-fold increased STFX MICs, compared to pre-treatment MICs. The STFX MICs did not increase, however, when the location of the mutations did not change after treatment. Double mutations in developed in 60.0% of the strains in which eradication failed, which exhibited a baseline mutation at position D91, and in 11.1% of strains with baseline mutations at position N87.
Acquisition of double mutations in evoked high-level resistance to STFX in after unsuccessful eradication with STFX-containing regimens.
尽管含司帕沙星（STFX）的治疗方案是治疗感染的有效挽救疗法，但在全球范围内，氟喹诺酮耐药性在中的流行率迅速上升。含STFX治疗失败后，耐药水平的变化以及作为氟喹诺酮耐药主要原因的突变情况尚未得到研究。
我们进行了一项回顾性、非随机研究，以比较2011年12月至2015年3月在庆应义塾大学医院使用含STFX方案根除失败前后，STFX的最低抑菌浓度（MIC）以及中的突变位置。
总共评估了266例接受含STFX方案进行三线根除治疗的患者。与治疗前MIC相比，20.8%的菌株STFX MIC增加了七倍，这些菌株获得了中的双重突变。然而，当治疗后中的突变位置未改变时，STFX MIC并未增加。根除失败的菌株中，60.0%的菌株在D91位有基线突变，11.1%的菌株在N87位有基线突变，这些菌株中出现了中的双重突变。
含STFX方案根除失败后，中的双重突变导致对STFX产生高水平耐药。
