Goni Elisabetta, Tammer Ina, Schütte Kerstin, Thon Cosima, Jechorek Dörthe, Mahajan Ujjwal Mukund, Vasapolli Riccardo, Macke Lukas, Aulinger Benedikt, Selgrad Michael, Link Alexander, Malfertheiner Peter, Schulz Christian
Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.
Otto-von-Guericke University Hospital, Institute of Medical Microbiology, Magdeburg, Germany.
Front Microbiol. 2022 Sep 23;13:938676. doi: 10.3389/fmicb.2022.938676. eCollection 2022.
Antibiotic susceptibility of to antibiotics may vary among different niches of the stomach. The progression of chronic gastritis to atrophy changes intragastric physiology that may influence selection of resistant strains.
To study the antibiotic resistance of taking the severity of atrophic gastritis in antrum and corpus into account.
-positive patients ( = 110, = 32, mean age 52.6 ± 13.9 years) without prior eradication undergoing upper gastrointestinal (GI) endoscopy for dyspeptic symptoms were included in a prospective study. Patients were stratified into three groups depending on the grade of atrophy: no atrophy (OLGA Stage 0), mild atrophy (OLGA Stage I-II) and moderate/severe atrophy (OLGA Stage III-IV). Two biopsies each from the antrum and the corpus and one from the angulus were taken and assessed according to the updated Sydney system. strains were isolated from antrum and corpus biopsies and tested for antibiotic susceptibility (AST) for amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin by the agar dilution methods. A Chi-square test of independence with a 95% confidence interval was used to detect differences in the proportion of patients with susceptible and resistant strains.
Among 110 patients, primary clarithromycin resistance (R) was 30.0%, both in the antrum and corpus; metronidazole resistance accounted for 36.4 and 34.5% in the antrum and corpus; and levofloxacin was 19.1 and 22.7% in the antrum and corpus, respectively. Resistance rates to amoxicillin, tetracycline, and rifampicin were below 5%. Dual antibiotic resistance rate was 21.8%, and triple resistance rate was 9.1%. There was a significant difference in the resistance rate distribution in antrum ( < 0.0001) and corpus ( < 0.0001). With increasing severity of atrophy according to OLGA stages, there was a significant increase in clarithromycin-R and metronidazole-R.
In treatment-naïve patients, antibiotic resistance and heteroresistance were related to the severity of atrophy. The high clarithromycin resistance in atrophic gastritis suggests that antibiotic susceptibility testing should always be performed in this condition before selecting the eradication regimen.
幽门螺杆菌对抗生素的敏感性在胃的不同微环境中可能有所不同。慢性胃炎进展为萎缩会改变胃内生理状态，这可能影响耐药菌株的选择。
考虑胃窦和胃体萎缩性胃炎的严重程度，研究幽门螺杆菌的抗生素耐药性。
对110例（男32例，平均年龄52.6±13.9岁）因消化不良症状接受上消化道内镜检查且未进行过幽门螺杆菌根除治疗的幽门螺杆菌阳性患者进行前瞻性研究。根据萎缩程度将患者分为三组：无萎缩（OLGA 0期）、轻度萎缩（OLGA I-II期）和中度/重度萎缩（OLGA III-IV期）。从胃窦、胃体各取两块活检组织，从胃角取一块活检组织，并根据更新后的悉尼系统进行评估。从胃窦和胃体活检组织中分离出幽门螺杆菌菌株，采用琼脂稀释法检测其对阿莫西林、克拉霉素、甲硝唑、左氧氟沙星、四环素和利福平的抗生素敏感性（AST）。采用95%置信区间的卡方独立性检验来检测敏感和耐药幽门螺杆菌菌株患者比例的差异。
110例患者中，胃窦和胃体的原发性克拉霉素耐药率均为30.0%；甲硝唑耐药率在胃窦和胃体分别为36.4%和34.5%；左氧氟沙星耐药率在胃窦和胃体分别为19.1%和22.7%。对阿莫西林、四环素和利福平的耐药率低于5%。双重抗生素耐药率为21.8%，三重耐药率为9.1%。胃窦（P<0.0001）和胃体（P<0.0001）的耐药率分布存在显著差异。随着OLGA分期萎缩程度的加重，克拉霉素耐药和甲硝唑耐药显著增加。
在未经治疗的患者中，抗生素耐药性和异质性耐药与萎缩程度有关。萎缩性胃炎中克拉霉素的高耐药性表明，在选择根除方案之前，这种情况下应始终进行幽门螺杆菌抗生素敏感性检测。
