Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Front Cell Infect Microbiol. 2023 Nov 28;13:1294379. doi: 10.3389/fcimb.2023.1294379. eCollection 2023.
The increasing prevalence of antibiotic resistance in cases of () infection has emerged as a significant global issue. This study offers a comprehensive examination of the alterations in drug resistance exhibited by in the Nanjing region of China during the preceding five years. Another important objective is to investigate the influence of levofloxacin medication history on genotypic and phenotypic resistance.
This research screened 4277 individuals diagnosed with infection between April 2018 and May 2023. The phenotype and genotypic resistance were evaluated using the Kirby-Bauer disk diffusion and PCR method.
The most recent primary resistance rates for metronidazole, clarithromycin, levofloxacin, amoxicillin, furazolidone, and tetracycline were recorded at 77.23% (2385/3088), 37.24% (1150/3088), 27.72% (856/3088), 0.52% (16/3088), 0.19% (6/3088), and 0.06% (2/3088), respectively. For the recent five years, we observed a notable upsurge in the rate of metronidazole resistance and a slight elevation of clarithromycin and levofloxacin resistance. The documented resistance rates to single-drug, dual-drug, triple-drug, and quadruple-drug regimens were 35.39%, 28.32%, 25.72%, and 0.21%, respectively. The prevalence of multidrug-resistant strains escalated, rising from 37.96% in 2018 to 66.22% in 2023. The rate of phenotypic and genotypic resistance rate (57.10% and 65.57%) observed in strains obtained from patients without a levofloxacin treatment history was significantly lower than the rate in strains obtained from those with a history of levofloxacin treatment (88.73% and 94.74%). The prevailing mutations were primarily N87K (52.35%, 345/659), accompanied by D91N (13.96%, 92/659), and closely followed by D87G (10.77%, 71/659). For mutations, the 91-amino acid mutants exhibit a higher likelihood of discrepancies between phenotypic and genotypic resistance than the 87-amino acid mutants.
The extent of antibiotic resistance within remains substantial within the Nanjing region. If levofloxacin proves ineffective in eradicating during the initial treatment, its use in subsequent treatments is discouraged. The employment of levofloxacin resistance genotype testing can partially substitute conventional antibiotic sensitivity testing. Notably, predicting phenotypic resistance of levofloxacin through PCR requires more attention to the mutation type of to improve prediction accuracy.
耐抗生素 () 感染的病例日益增多，已成为一个重大的全球问题。本研究全面研究了过去五年中国南京地区 对抗生素耐药性的变化。另一个重要目标是研究左氧氟沙星用药史对基因型和表型耐药性的影响。
本研究筛选了 2018 年 4 月至 2023 年 5 月期间诊断为 感染的 4277 人。使用 Kirby-Bauer 磁盘扩散和 PCR 方法评估表型和基因型耐药性。
最近的甲硝唑、克拉霉素、左氧氟沙星、阿莫西林、呋喃唑酮和四环素的原发性耐药率分别为 77.23%（2385/3088）、37.24%（1150/3088）、27.72%（856/3088）、0.52%（16/3088）、0.19%（6/3088）和 0.06%（2/3088）。在过去的五年中，我们观察到甲硝唑耐药率显著上升，克拉霉素和左氧氟沙星耐药率略有上升。单药、二联、三联和四联耐药率分别为 35.39%、28.32%、25.72%和 0.21%。多药耐药株的流行率上升，从 2018 年的 37.96%上升到 2023 年的 66.22%。未接受左氧氟沙星治疗的患者分离株的表型和基因型耐药率（57.10%和 65.57%）明显低于接受左氧氟沙星治疗的患者分离株（88.73%和 94.74%）。主要的 突变是 N87K（52.35%，345/659），其次是 D91N（13.96%，92/659），其次是 D87G（10.77%，71/659）。对于 突变，91 个氨基酸突变体比 87 个氨基酸突变体更有可能出现表型和基因型耐药性之间的差异。
南京地区 对抗生素的耐药程度仍然很高。如果左氧氟沙星在初始治疗中不能有效根除 ，则不建议在后续治疗中使用。左氧氟沙星耐药基因型检测可部分替代常规抗生素敏感性检测。值得注意的是，通过 PCR 预测左氧氟沙星的表型耐药性需要更多关注 突变的类型，以提高预测的准确性。
