Macrolide resistance in the normal microbiota after Helicobacter pylori treatment
Macrolide resistance in the normal microbiota after Helicobacter pylori treatment
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DOI：
10.1080/00365540701299608
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发表时间：
2007-01-01
影响因子：
--
通讯作者：
Engstrand, Lars
中科院分区：
文献类型：
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作者：
Jakobsson, Hedvig;Wreiber, Karin;Engstrand, Lars
通过根除幽门螺杆菌大规模化学预防消化性溃疡疾病和胃癌将使大量人群暴露于抗生素，这引起了对抗生素耐药性可能传播的担忧。本队列研究的目的是确定含有奥美拉唑、克拉霉素和甲硝唑的三联治疗幽门螺杆菌感染是否会增加正常菌群中大环内酯类药物耐药性的发生率。85例确诊幽门螺杆菌感染的消化性溃疡患者和12例内窥镜检查未发现阳性结果的消化不良患者纳入研究。克拉霉素对葡萄球菌、链球菌、肠球菌和拟杆菌的最低抑菌浓度分别在治疗前后和1年后测定。治疗前，葡萄球菌、链球菌、肠球菌和拟杆菌对大环内酯类药物的耐药率分别为11%、31%、9%和11%。耐药菌株的数量在1年后仍然升高，最明显的是葡萄球菌和链球菌。未治疗对照组未发现持续耐药。包括克拉霉素在内的三联治疗导致正常菌群持续耐大环内酯类药物。正常菌群中普遍存在的耐药基因构成了一种生态危害，在实施根除幽门螺杆菌的全球治疗规划之前需要加以考虑。
Large-scale chemoprevention of peptic ulcer disease and gastric cancer through eradication of Helicobacter pylori would expose large population groups to antibiotics, which raises concerns about possible dissemination of antibiotic resistance. The objective of this cohort study was to determine whether a triple therapy, containing omeprazole, clarithromycin, and metronidazole, of H. pylori infection increases the prevalence of macrolide resistance in the normal microbiota. 85 patients with a peptic ulcer disease with verified H. pylori infection and 12 dyspeptic patients without positive findings upon endoscopy were included. Minimal inhibitory concentrations of clarithromycin for Staphylococcus, Streptococcus, Enterococcus and Bacteroides spp. were determined from samples taken before and after treatment, and 1 y later. Before treatment, macrolide resistance was observed in 11%, 31%, 9% and 11% of the staphylococci, streptococci, enterococci and Bacteroides, respectively. The number of resistant isolates remained elevated after 1 y, most notably for staphylococci and streptococci. No development of persistent resistance was detected in the untreated control group. Triple therapy including clarithromycin leads to persistent macrolide resistance in the normal microbiota. A prevalent pool of resistance genes in the normal microbiota constitutes an ecological hazard that needs to be considered before global treatment programmes for eradication of H. pylori are implemented.