High incidence of antibiotic resistance amongst isolates of Helicobacter pylori collected in Nottingham, UK, between 2001 and 2018
High incidence of antibiotic resistance amongst isolates of Helicobacter pylori collected in Nottingham, UK, between 2001 and 2018
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DOI：
10.1099/jmm.0.001776
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发表时间：
2023-01-01
影响因子：
3
通讯作者：
Robinson，Karen
中科院分区：
文献类型：
--
作者：
Garvey，Elizabeth;Rhead，Joanne;Robinson，Karen
幽门螺杆菌是引起消化性溃疡和胃癌的主要原因。最常见的治疗方案使用两种或三种抗生素和质子泵抑制剂（PPI）的组合来抑制胃酸。世界卫生组织将其命名为克拉霉素耐药菌H。由于全球抗生素耐药性的增加，幽门螺杆菌是药物开发的高度优先考虑的病原体。pylori primary antimicrobial sensitivity in the UK，and published data are lacked.Aim.本研究旨在描述2001年至2018年期间在英国诺丁汉收集的菌株的抗菌药物敏感性。Methodology. Gastric biopsy样本收集，知情同意书和伦理批准，来自诺丁汉女王医疗中心的162名患者，进行上消化道内窥镜检查。抗生素敏感性进行了评估，使用E-测试和更具成本效益的光盘diffusion test.Results.The克拉霉素，阿莫西林和左氧氟沙星光盘扩散试验提供了相同的结果，E-测试的一个子集的30株。然而，在甲硝唑试验结果中观察到了差异。总共使用至少一种方法检测了来自162例患者的241株分离株。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，这些药物用于一线治疗。 对于二线和三线治疗中使用的抗生素，4%的菌株对左氧氟沙星耐药，没有菌株对四环素耐药。 在27%的分离株中发现对一种以上抗生素的耐药性。 克拉霉素耐药菌株患者的频率随着时间的推移急剧增加：从2001年至2005年的16%增加到2011年至2018年的40%（P=0.011）。 在同一时间段内，甲硝唑耐药菌株的比例也有所增加（从58%增加到78%;P=0.05）。 既往接受过根除治疗的患者分离株中克拉霉素和甲硝唑耐药的频率高于未接受过根除治疗的患者（分别为40%和77%，80%和92%）。 79对菌株从胃窦和体部地区的同一病人的胃，只有6个有不同的抗菌药物的敏感性profiles.Conclusion。虽然有高耐药性克拉霉素和甲硝唑，并不断增加，没有耐药性四环素和阿莫西林和左氧氟沙星耐药的频率是非常低的。
Introduction.Helicobacter pyloriis 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-resistantH. pylorias a high priority pathogen for drug development, due to increasing antibiotic resistance globally.Hypothesis/Gap Statement.There is no routine surveillance ofH. pyloriprimary antimicrobial sensitivities in the UK, and published data are lacking.Aim.This study aimed to characterize antimicrobial sensitivities of isolates collected in Nottingham, UK, between 2001 and 2018.Methodology.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.Results.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 (P=0.011). For the same time periods, there was also an increase in those with a metronidazole-resistant strain (from 58 to 78 %;P=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.Conclusion.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.