Peren H. BAĞLAN, Gülendam BOZDAYI, Muhip ÖZKAN, Ali ÖZDEN

Klaritromisin dirençli Helicobacter pylori'nin saptanmasında E-test ve Agar dilüsyon metodlarının karşılaştırılması

Giriş ve amaç: H. pylori, dünyada en sık rastlanan kronik bakteriyel enfeksiyondur. H. pylori'nin antimikrobiyal ajanlara direnç kazanmasından dolayı tedavide başarısızlıklar meydana gelmektedir. Çalışmamızın amacı Ankara Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı'na, dispeptik yakınmalarla gelen H. pylori pozitif hastalarda, klaritromisine direnç sıklığını, agar dilüsyon ve E-Test yöntemleri gibi 2 ayrı yöntemle belirlemek ve 2 yöntemi karşılaştırmaktır. Gereç ve yöntem: Çalışmaya dispeptik yakınmalar nedeniyle endoskopik incelemeleri yapılan, 22-76 yaşları arasında (yaş ortalaması: 51+13), 43'ü kadın, 34'ü erkek toplam 77 hasta dahil edilmiştir. Endoskopik incelemesi yapılan 77 hastanın, 41'i gastrit, 13'ü gastrik ya da duodenal ülser, 3'ü normal, 20'si ise gastroduodenit, hiatus hernisi, alt özofagus sfinkter gevşekliği, özo-fajit veya bulbutis tanılarından birini almıştır. H. pylori, at kanı içeren BHI ağarda 37°C'de 72 saat inkübe edilmiştir. Klaritromisin direncinin belirlenmesi için ise, NCCLS standartlarına uygun agar dilüsyon ve E-test yöntemleri yapılmıştır. MIC değeri 1u.g/ml olan suşlar klaritromisine dirençli kabul edilmiştir. Bulgular: Çalışmaya alınan 77 hastanın, agar dilüsyon yöntemi ile 43'ünde (%55.8), E-Test yöntemi ile de 42'sinde (%54.5) klaritromisine direnç saptanmıştır. E-Test yöntemi ile yapılan MIC değerleri ile agar dilüsyon yöntemi ile yapılan MIC değerleri arasındaki uyumluluk istatistiksel olarak anlamlı bulunmuştur (r= 0,864, p

Anahtar Kelimeler:

Helicobacter pylori, Dispepsi, Koloni sayımı, mikrobiyal, Klaritromisin, İlaç direnci, bakteriyel

Comparison of the E-test and the Agar dilution method to detect clarithyromycin resistant Helicobacter pylori

Background/aim: H. pylori is the most common chronic bacterial infection in the world. Because of H, pylori's acquired resistance to antimicrobial agents, treatment failure occurs. The aim of our study was to determine the prevalence of clarithromycin resistance in dyspeptic H. pylori -positive patients who applied to Ankara University School of Medicine, Department of Gastroenterology, by two methods - agar dilution and E-test - and to compare these two methods. Materials and methods: Seventy-seven H. pvfon'-positive patients (43 female, 34 male) were included in the study, aged between 22-76 (mean age: 51±13). Forty-one of the patients were diagnosed with gastritis, 13 were peptic or duodenal ulcer, 3 were normal gastrointestinal system, and 20 were diagnosed with one of the following diseases: gastroduodenitis, hiatal hernia, bulbitis or esophageal reflux. H. pylori culture was made with BHI agar and horse blood medium and incubated at 37°C for 72 hours. To determine the clarithromycin resistance, agar dilution and E-test methods were applied in accordance with NCCLS standards. Strains with MIC >1 u.g/ml were accepted as resistant. Results: In 77 patients, 43 (55.8%) patients were resistant with agar dilution method and 42 (54.5%) were determined as resistant using the E-test method. There was a significant correlation between the MICs using the E-test and agar dilution (r=0.0864, p>0.01). Conclusion: A comparison of our results with other studies shows similarities with some and discrepancies with others, demonstrating an increase in clarithromycin resistance over time. Two different methods, agar dilution and E-test, were applied to the same strains to determine the resistance. Our results showed statistical significance with the two methods, thus either can be used to determine resistance. It is important to know the clarithromycin resistance of the patient, to prevent its increase.

Keywords:

Helicobacter pylori, Dyspepsia, Colony Count, Microbial, Clarithromycin, Drug Resistance, Bacterial,

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