目的和目标：
幽门螺杆菌已于2017年被WHO列为高度优先病原体。抗生素耐药菌株的出现是幽门螺杆菌感染治疗失败的主要原因之一。这项研究确定并鉴定了马来西亚幽门螺杆菌的原发性和继发性抗性。

材料和方法：
胃窦活检（n = 288）和胃体活检（n = 283）是从马来西亚吉隆坡马来西亚大学医学中心（UKMMC）接受内窥镜检查的288例患者中获得的。通过E检验确定了对六类抗生素的抗生素敏感性。通过PCR和测序鉴定了赋予功能基因抗性的突变。

结果：
甲硝唑，克拉霉素和左氧氟沙星的总耐药率分别为59.3％（35/59），35.6％（21/59）和25.4％（15/59）。与初级分离株相比，次级分离株对克拉霉素的耐药率明显更高。在16.2％（6/37）的病例中观察到易感和耐药菌的混合感染，其中83.3％（n = 5）感染了同一菌株。 41％（18/44）的分离株对一种以上的抗生素具有抗药性，其中50％（9/18）的抗生素具有多重耐药性，其中两种是主要的，而7种是次要的。 rdxA，23S rRNA和gyrA基因的突变分别与甲硝唑，克拉霉素和左氧氟沙星的耐药有关。

结论：
在我们的环境中，幽门螺杆菌分离株对甲硝唑，克拉霉素和左氧氟沙星的耐药性很高，因此有必要进行持续监测，并强调在根除幽门螺杆菌的一线治疗中应谨慎使用抗生素。

AIMS AND OBJECTIVES:
Helicobacter pylori has been classified as high priority pathogen by the WHO in 2017. The emergence of antibiotic-resistant strains is one of the main causes of treatment failure in H. pylori infection. This study determined and characterized primary and secondary resistances in H. pylori in Malaysia.

MATERIALS AND METHODS:
Gastric biopsies from antrum (n=288) and corpus (n=283) were obtained from 288 patients who underwent endoscopy at Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia. Antibiotic susceptibility to six classes of antibiotics was determined by the E-test. Mutations conferring in resistance in functional genes were identified by PCR and sequencing.

RESULTS:
Overall resistance rates to metronidazole, clarithromycin and levofloxacin were 59.3% (35/59), 35.6% (21/59) and 25.4% (15/59), respectively. Secondary isolates showed significantly higher resistance rates to clarithromycin compared to the primary isolates. Mixed infection with susceptible and resistant isolates was observed in 16.2% (6/37) of cases, of which 83.3% (n=5) had infection with the same strain. 41% (18/44) of isolates were resistant to more than one class of antibiotics of which 50% (9/18) were multidrug-resistant, two being primary and seven being secondary isolates. Mutations in rdxA, 23S rRNA and gyrA genes were associated with resistance to metronidazole, clarithromycin and levofloxacin, respectively.

CONCLUSION:
The high level of resistance to metronidazole, clarithromycin and levofloxacin seen in H. pylori isolates in our setting warrants the need for continuous surveillance and highlights caution in use of antibiotics generally used as first-line therapy in H. pylori eradication regimen.

https://www.ncbi.nlm.nih.gov/pubmed/31632095