Hp临床分离株对5种抗生素的耐药性分析

目的通过对幽门螺杆菌（helcobacter pylori,Hp）药物敏感性检测,为临床根除Hp感染合理选择抗生素提供依据。方法148株Hp临床株分别来自148位有上消化道症状患者,采用纸片扩散法检测Hp对甲硝唑、克拉霉素、阿莫西林、左氧氟沙星和呋喃唑酮的敏感性,并对敏感性进行分析。结果Hp对甲硝唑、克拉霉素、阿莫西林、左氧氟沙星和呋喃唑酮的耐药率分别为79.0%、23.6%、2.0%、33.1%和2.0%。56例菌株（56/148,37.8%）对2种或3种抗生素同时耐药。耐药率在不同疾病类型中没有差异。甲硝唑在女性患者中的耐药率高于男性患者（P〈0.05）,其他4种抗生素的耐药率与性别无关。经抗Hp治疗的患者与未曾治疗患者的Hp对甲硝唑耐药率差异无统计学意义（P〉0.05）,对克拉霉素、左氧氟沙星耐药率差异有统计学意义（P〈0.05）。结论Hp对甲硝唑的耐药率很高,不应作为一线药物使用;对克拉霉素、左氧氟沙星的耐药率已经比较高,应在药敏检测指导下选择应用;对阿莫西林、呋喃唑酮的耐药率很低,应作为根除Hp的主要药物。

Clinical analysis of resistance of Hp isolates to five antibiotics

Objective To study the resistance of Helicobacter pylori （Hp） to antibiotics by drug susceptibility test and to provide the clinical guidelines for choosing effective agents for Hp eradication therapy. Methods A total of 148 Hp strains were isolated from biopsy specimens of patients with upper abdominal symptoms. The determination of Hp antibiotic susceptibility was based on the disk diffusion tests of metronidazole, clarithromycin, amoxicillin, furazolidone and levofloxacin, and the characteristics of susceptibility were analyzed. Results The rate of Hp resistance to metronidazole was 79. 0%, to clarithromycin 23.6%, to amoxicillin 2.0%, to levofloxacin 33.1%, and to furazolidone 2.0%. Fifty-six strains （56/148,37.8%） exhibited double or triple resistance. No relationships were found between the resistence and disease subtypes. The rate of Hp resistance to metronidazole was higher in female patients than that in male patients （ P 〈 0.05 ）, while resistance to other drugs was not associated with gender. The rates of Hp resistance to metronidazole in treated and untreated patients were comparable, while the rates of Hp resistance to clarithromycin and levofloxacin were significantly h~gt~er m treatea pauents man mo~ ,,~ untreated patients. Conclusion The results demonstrate that metronidazole should not be used as first-line agent for Hp treatment due to its higher resistance rate. The rates of Hp resistance to clarithrornycin and levofloxacin were higher, so both the medicines should be tested before the initiation of therapy. Amoxicillin and furazolidone should be considered to apply for Hp eradication therapy because of the lower resistance rate.