Mixed-infection of antibiotic susceptible and resistant Helicobacter pylori isolates in a single patient and underestimation of antimicrobial susceptibility testing
Mixed-infection of antibiotic susceptible and resistant Helicobacter pylori isolates in a single patient and underestimation of antimicrobial susceptibility testing
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DOI：
10.1046/j.1523-5378.2003.00145.x
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发表时间：
2003-06-01
期刊：
影响因子：
4.4
通讯作者：
Kwon, DH
中科院分区：
文献类型：
--
作者：
Kim, JJ;Kim, JG;Kwon, DH
幽门螺杆菌的耐药性在全球范围内一直在增加，并已开始对当前抗生素方案的整体疗效产生不利影响。我们检测了220对分别来自患者胃窦和胃体的Hp分离株；109株(50%)对抗生素具有耐药性：阿莫西林(0.5%)、克拉霉素(5.9%)、呋喃唑酮(1.4%)、甲硝唑(45.5%)、呋喃妥因(1.4%)和四环素(6.8%)。在109例对抗生素耐药的幽门螺杆菌患者中，41例(38%)患者的两个活检部位存在异质性耐药(例如，如果仅将胃窦活检用于药敏试验，34%的耐药菌株将被错误归类为敏感菌株)。对41对异源耐药菌株进行了DNA指纹图谱分析。虽然不同的患者有不同的指纹模式，但每对分离株都显示出相同或相似的指纹模式。这些结果表明，耐药幽门螺杆菌通常是从先前存在的敏感菌株发展而来的，而不是与不同的菌株混合感染。所看到的微小的基因差异(基因的退化)反映了幽门螺杆菌遗传多样性的发展过程之一。没有单一的活检点可以被认为具有抗菌药敏感性试验的代表性。
Antibiotic resistance among Helicobacter pylori has been increasing worldwide and has begun to affect the overall efficacy of current antibiotic regimens adversely. We examined 220 pairs of H. pylori isolates obtained from both the antrum and corpus of separate patients; 109 (50%) harbored antibiotic-resistant H. pylori: amoxicillin (0.5%), clarithromycin (5.9%), furazolidone (1.4%), metronidazole (45.5%), nitrofurantoin (1.4%), and tetracycline (6.8%). Heteroresistance among the two biopsy sites from each patient was present in 41 of the 109 patients (38%) with antibiotic resistant H. pylori (e.g. 34% with resistant strains would be misclassified as susceptible if a biopsy of the antrum alone used for antimicrobial susceptibility testing). DNA fingerprinting genotype analysis was carried out on the 41 pairs of isolates with heteroresistance. While different patients had different fingerprinting patterns, each pair of isolates showed identical or similar fingerprinting patterns. These results suggest that antibiotic-resistant H. pylori typically develop from pre-existing susceptible strain rather than coinfection with a different strain. The minor differences in genotype (degeneration of genotype) seen reflect one of the processes for development of genetic diversity in H. pylori. No biopsy single site can be considered representative for antimicrobial susceptibility testing.