Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham, UK.
NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
J Med Microbiol. 2023 Nov;72(11). doi: 10.1099/jmm.0.001776.
is the leading cause of peptic ulcers and gastric cancer. The most common treatment regimens use combinations of two or three antibiotics and a proton pump inhibitor (PPI) to suppress stomach acid. The World Health Organization designated clarithromycin-resistant as a high priority pathogen for drug development, due to increasing antibiotic resistance globally. There is no routine surveillance of primary antimicrobial sensitivities in the UK, and published data are lacking. This study aimed to characterize antimicrobial sensitivities of isolates collected in Nottingham, UK, between 2001 and 2018. Gastric biopsy samples were collected, with informed written consent and ethics approval, from 162 patients attending the Queen's Medical Centre in Nottingham for an upper GI tract endoscopy. Antibiotic sensitivity was assessed using E-Tests and a more cost-effective disc diffusion test. The clarithromycin, amoxicillin and levofloxacin disc diffusion tests provided identical results to E-Tests on a subset of 30 isolates. Disparities were observed in the metronidazole test results, however. In total, 241 isolates from 162 patients were tested using at least one method. Of all isolates, 28 % were resistant to clarithromycin, 62 % to metronidazole and 3 % to amoxicillin, which are used in first-line therapies. For those antibiotics used in second- and third-line therapies, 4 % were resistant to levofloxacin and none of the isolates were resistant to tetracycline. Resistance to more than one antibiotic was found in 27 % of isolates. The frequency of patients with a clarithromycin-resistant strain increased dramatically over time: from 16 % between 2001 and 2005 to 40 % between 2011 and 2018 (=0.011). For the same time periods, there was also an increase in those with a metronidazole-resistant strain (from 58 to 78 %; =0.05). The frequencies of clarithromycin and metronidazole resistance were higher in isolates from patients who had previously received eradication therapy, compared to those who had not (40 % versus 77 %, and 80 % versus 92 %, respectively). Of 79 pairs of isolates from the antrum and corpus regions of the same patient's stomach, only six had differences in their antimicrobial susceptibility profiles. Although there was high and increasing resistance to clarithromycin and metronidazole, there was no resistance to tetracycline and the frequencies of amoxicillin and levofloxacin resistance were very low.
幽门螺杆菌是消化性溃疡和胃癌的主要病因。最常见的治疗方案是使用两种或三种抗生素联合质子泵抑制剂（PPI）来抑制胃酸。由于全球抗生素耐药性的增加，世界卫生组织将克拉霉素耐药的幽门螺杆菌指定为药物开发的高优先级病原体。英国没有常规监测幽门螺杆菌的主要抗菌敏感性，也缺乏已发表的数据。本研究旨在描述 2001 年至 2018 年间在英国诺丁汉采集的分离株的抗菌敏感性。从因上消化道内镜检查而在诺丁汉皇后医疗中心就诊的 162 名患者中采集胃活检样本，并获得知情书面同意和伦理批准。使用 E 试验和更具成本效益的圆盘扩散试验评估抗生素敏感性。克拉霉素、阿莫西林和左氧氟沙星的圆盘扩散试验结果与 30 个分离株子集的 E 试验结果相同。然而，甲硝唑试验结果存在差异。共有 162 名患者的 241 个分离株使用至少一种方法进行了测试。在所有分离株中，28%对克拉霉素耐药，62%对甲硝唑耐药，3%对阿莫西林耐药，这些都是一线治疗药物。对于二线和三线治疗中使用的抗生素，4%对左氧氟沙星耐药，没有分离株对四环素耐药。27%的分离株对多种抗生素耐药。克拉霉素耐药株患者的比例随时间急剧增加：从 2001 年至 2005 年的 16%增加到 2011 年至 2018 年的 40%（=0.011）。同一时期，甲硝唑耐药株患者的比例也有所增加（从 58%增加到 78%；=0.05）。与未接受根除治疗的患者相比，先前接受过根除治疗的患者的分离株中克拉霉素和甲硝唑耐药率更高（分别为 40%对 77%，80%对 92%）。在同一患者胃的胃窦和胃体区域的 79 对分离株中，只有 6 对的抗菌敏感性谱存在差异。尽管克拉霉素和甲硝唑的耐药率很高且呈上升趋势，但对四环素没有耐药性，阿莫西林和左氧氟沙星的耐药率非常低。
