Annals of internal medicine · 2003
Long-term persistence of resistant Enterococcus species after antibiotics to eradicate Helicobacter pylori.
СтатьяПоддержка исследования: вне правительства СШАПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод пока не подготовлен
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Sjölund Maria, Wreiber Karin, Andersson Dan I, Blaser Martin J, Engstrand Lars
Аннотация
BACKGROUND: Antibiotic treatment selects for resistance not only in the pathogen to which it is directed but also in the indigenous microflora.
OBJECTIVE: To determine whether a widely used regimen (clarithromycin, metronidazole, and omeprazole) for Helicobacter pylori eradication affects resistance development in enterococci.
DESIGN: Cohort study.
SETTING: Endoscopy units at 3 community hospitals in Sweden.
PATIENTS: 5 consecutive dyspeptic patients who were colonized with H. pylori, had endoscopy-confirmed duodenal ulcer, and received antibiotic treatment, and 5 consecutive controls with dyspepsia but no ulcer who did not receive treatment.
MEASUREMENTS: Fecal samples were obtained from patients and controls before, immediately after, 1 year after, and 3 years after treatment. From each patient and sample, enterococci were isolated and analyzed for DNA fingerprint, clarithromycin susceptibility, and presence of the erm(B) gene.
RESULTS: In treated patients, all enterococci isolated immediately after treatment showed high-level clarithromycin resistance due to erm(B). In 3 patients, resistant enterococci persisted for 1 to 3 years after treatment. No resistance developed among controls.
CONCLUSION: A common H. pylori treatment selects for highly resistant enterococci that can persist for at least 3 years without further selection.
OBJECTIVE: To determine whether a widely used regimen (clarithromycin, metronidazole, and omeprazole) for Helicobacter pylori eradication affects resistance development in enterococci.
DESIGN: Cohort study.
SETTING: Endoscopy units at 3 community hospitals in Sweden.
PATIENTS: 5 consecutive dyspeptic patients who were colonized with H. pylori, had endoscopy-confirmed duodenal ulcer, and received antibiotic treatment, and 5 consecutive controls with dyspepsia but no ulcer who did not receive treatment.
MEASUREMENTS: Fecal samples were obtained from patients and controls before, immediately after, 1 year after, and 3 years after treatment. From each patient and sample, enterococci were isolated and analyzed for DNA fingerprint, clarithromycin susceptibility, and presence of the erm(B) gene.
RESULTS: In treated patients, all enterococci isolated immediately after treatment showed high-level clarithromycin resistance due to erm(B). In 3 patients, resistant enterococci persisted for 1 to 3 years after treatment. No resistance developed among controls.
CONCLUSION: A common H. pylori treatment selects for highly resistant enterococci that can persist for at least 3 years without further selection.