海南省幽门螺杆菌耐药性监测

Monitoring of Resistance to Antibiotics of Helicobacter Pylori Strains in Hainan Province

目的监测海南省幽门螺杆菌(H.pylori)菌株对甲硝唑、克拉霉素、环丙沙星、四环素、阿莫西林的耐药情况。方法采取海南省各地门诊及住院胃病的胃镜活检标本326例,在微需氧环境下培养,经生化、涂片检查,鉴定为典型的H.pylori中96例获得临床分离。应用E-test方法测定H.pylori对甲硝唑、克拉霉素、环丙沙星、四环素、阿莫西林的最低抑菌浓度(MIC,mg/L)。结果96株H.pylori菌株中,甲硝唑的耐药率为82.3%(79/96),MIC范围0.016～256 mg/L;克拉霉素的耐药率为26.0%(25/96),MIC范围0.016～256mg/L;环丙沙星的耐药率为21.9%(21/96),MIC范围0.02～32mg/L;四环素的耐药率为0%(0/96), MIC范围0.016～1.5 mg/L;阿莫西林的耐药率为4.2%(4/96),MIC范围0.016～8 mg/L;甲硝唑和克拉霉素的同时耐药率为14.6%(14/96)。不同性别间的耐药率无明显差异(P>0.05)。结论海南地区H.pylori对甲硝唑的耐药率(82.3%)高,对克拉霉素、环丙沙星的耐药(26.0%、21.9%)有一定的比例,对阿莫西林的耐药菌株(4.2%)也已出现,未见对四环素耐药(耐药率为0%)。

Objective To monitor the the resistance to metronidazole, clarithromycin, ciprofloxacin, tetracycline and amoxicillin of Helicobacter pylori （H. pylori） strains in Hainan Province. Method The tissue sampies were collected by gastroscope biopsy from the outpatients and inpatients with gastric diseases. 96 tissue sampies cultured under farthing oxygen condition were identified as typical H. pylori strains by biochemical and slice checking methods. E-test method was used to measure the minimum inhibitory concentration （MIC） of these indentified H. pylori strains resistant to these antibiotics. Result Among 96 H. pylori strains, the resistance rate to metronidazole was 82.3%（79/96）, and the MIC ranged from 0.016 mg/L to beyond 256 mg/L; to clarithromycin, 26.0%（25/96）, MIC ranged from 0.016 mg/L to beyond 256 mg/L; to ciprofloxacin, 21.9%（21/96）, MIC from 0.02 mg/L to 32 mg/L; tetracycline 0%（0/96）, MIC from 0.016 mg/L to 1.5 mg/L; amoxicillin 4.2%（4/96）, MIC from 0.016 mg/L to 8 mg/L; the resistance rate to both metronidazole and clarithromycin were 14.6%（14/96）. There was no significant difference between different genders （P〉0.05）. Conclusion In Hainan Province, the resistance rate of H. pylori to metronidazole was the highest（82.3%）, and the second was to clarithromycin and ciprofloxacin （26.0%, 21.9% respectively）. It is interesting that the H. pylori strain resistant to amoxicillin appeared. There have been no H. pylori strains resistant to tetracycline up to now.