Xia H H, Kalantar J, Talley N J
Department of Medicine, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia.
J Gastroenterol Hepatol. 1998 Oct;13(10):1044-9. doi: 10.1111/j.1440-1746.1998.tb00568.x.
It is unknown whether antibiotic susceptibility testing of antral isolates alone is representative of Helicobacter pylori susceptibility. We aimed to determine: (i) the prevalence of metronidazole- and clarithromycin-resistant strains in infected dyspeptic patients; and (ii) whether there is consistency in the susceptibility to metronidazole and clarithromycin among isolates cultured from different gastric sites. Antral, body and fundus biopsies were taken from 242 consecutive patients and cultured on blood agar under micro-aerophilic conditions for 5-7 days. Isolates from 66 patients (13 had one, 15 had two and 38 had three isolates) were tested for susceptibility to metronidazole and clarithromycin using previously validated disc diffusion tests. Of the 66 patients, 42 (64%) had strains resistant to metronidazole while four (6.1%) had clarithromycin-resistant strains. The prevalence of metronidazole resistance was not significantly different between men and women (65% vs 60%) or across different age groups. In five (9.4%) of the 53 patients with multiple isolates, discrepant results for metronidazole susceptibility were observed: susceptible antral and body isolates but resistant fundus isolates in two cases and susceptible antral isolates but resistant body and fundus isolates in the others. Clarithromycin susceptibilities were consistent among the isolates cultured from different gastric sites in all patients. It is concluded that metronidazole-resistant strains of H. pylori are common while clarithromycin-resistant strains are rare. Metronidazole susceptibility testing of antral isolates does not appear to be representative of isolates from the body and fundus in a subset of patients.
仅对胃窦分离株进行抗生素敏感性测试是否能代表幽门螺杆菌的易感性尚不清楚。我们旨在确定：（i）感染消化不良患者中甲硝唑和克拉霉素耐药菌株的患病率；以及（ii）从不同胃部位培养的分离株对甲硝唑和克拉霉素的易感性是否一致。从242例连续患者中采集胃窦、胃体和胃底活检组织，在微需氧条件下于血琼脂上培养5 - 7天。使用先前验证的纸片扩散试验对66例患者（13例有1株分离株，15例有2株分离株，38例有3株分离株）的分离株进行甲硝唑和克拉霉素敏感性测试。在这66例患者中，42例（64%）有对甲硝唑耐药的菌株，而4例（6.1%）有对克拉霉素耐药的菌株。甲硝唑耐药率在男性和女性之间（65%对60%）或不同年龄组之间没有显著差异。在53例有多个分离株的患者中，5例（9.4%）观察到甲硝唑敏感性结果不一致：2例胃窦和胃体分离株敏感但胃底分离株耐药，其余3例胃窦分离株敏感但胃体和胃底分离株耐药。所有患者中，从不同胃部位培养的分离株对克拉霉素的敏感性是一致的。结论是，幽门螺杆菌甲硝唑耐药菌株常见，而克拉霉素耐药菌株罕见。在一部分患者中，对胃窦分离株进行甲硝唑敏感性测试似乎不能代表胃体和胃底的分离株。
