ABSTRACT
Objetivo: determinar la frecuencia de resistencia del Helicobacter pylori (H. pylori) a amoxicilina, claritromicina, tetraciclina y metronidazol en el Hospital Universitario San Ignacio en Bogotá, y buscar correlación entre la presencia de resistencia y el antecedente de consumo previo de antibióticos. Material y métodos: se estudiaron 115 muestras para cultivo de H. pylori tomadas de pacientes sometidos a endoscopia digestiva alta por síntomas dispépticos. Se determinó la susceptibilidad a antibióticos mediante discos de infusión en los cultivos. Se investigaron los antecedentes de consumo previo de antibióticos e imidazoles y se buscó asociación entre este antecedente y la de resistencia mediante tablas de contingencia y la prueba exacta de Fisher. Resultados: se obtuvieron 84 cultivos positivos para H. pylori. Se encontró resistencia a metronidazol en 97,6% de los cultivos, seguida por la resistencia a tetraciclina (85,7%), a claritromicina (63,1%) y a amoxicilina (9,5%). No se encontró relación entre el uso previo de imidazoles o antibióticos y la resistencia a los antibióticos estudiados. Tampoco se encontró asociación entre resistencia antibiótica y otras variables como edad, sexo o hallazgos endoscópicos. Se encontró una mayor probabilidad de resistencia a la claritromicina si había resistencia a la tetraciclina. (RR 4,25; IC 1,18-15,19 p= 0,001). Conclusiones: la resistencia del H. pylori a metronidazol y a tetraciclina sobrepasan el 85% y a claritromicina es superior al 60% en la población estudiada. El antecedente de consumo previo de antibióticos no permite predecir una mayor probabilidad de resistencia. Dado que estos antibióticos son los más usados en los esquemas de erradicación del H. pylori, se debe evaluar en experimentos clínicos la repercusión de estos hallazgos en la efectividad de los diferentes esquemas de erradicación.
Objectives: to determine the frequency of resistance of Helicobacter pylori (H. pylori) to amoxicillin, clarithromycin, tetracyclin and metronidazole at the San Ignacio University Hospital in Bogotá, and to look for correlation between the presence of resistance and previous antibiotic use. Material and methods: samples for H. pylori cultures were taken from 115 patients who underwent endoscopy because of dyspeptic symptoms. Resistance to antibiotics was determined by means of susceptibility discs. Information was collected on previous antibiotic and imidazole intake, and associations with resistance evaluated by means of contingency tables and Fischer s exact test. Results: 84 positive cultures for H. pylori were obtained. Resistance to metronidazole was found in 97,6% of cultures, followed by resistance to tetracycline (85,7%), to clarithromycin (63,1%) and to amoxicillin (9,5%). No relationship was found between previous use of antibiotics or imidazoles and the resistance to studied antibiotics. No associations were found between antibiotic resistance and other variables like age, sex or endoscopic findings. There was an increased probability of resistance to clarithromycin if there was also resistance to tetracycline (RR 4.25, IC 1.18-15.19 p= 0.001). Conclusions: resistances of H. pylori to metronidazol and to tetracycline are above 85%, and to clarithromycin above 60% in the studied population. History of previous intake of antibiotics does not increase the probability of resistance. Since these antibiotics are amongst the most widely used for eradication of H. pylori, the clinical impact of these findings in the effectiveness of eradication regimens must be evaluated with clinical trials.
ABSTRACT
OBJECTIVE: This study was performed to compare the prooxidative activity stimulating the protein carbonyl formation by 3rd generation cephalosporin (moxalactam) and amoxacillin in the uterine venous, umbilical venous, and umbilical arterial plasma of preeclampsia with that of normal pregnancy. METHODS: Lipid peroxide levels in the uterine venous, umbilical venous, and umbilical arterial plasma of normal pregnancy (n=16) and preeclampsia (n=16) were measured by thiobarbituric acid reaction. The basal protein carbonyl contents in the uterine venous, umbilical venous, and umbilical arterial plasma of normal pregnancy (n=16) and preeclampsia (n=16) were determined by the 2,4-dinitrophenylhydrazine (DNPH) method. After plasma of them were mixed and incubated up to 5 hours with 0.2 mL of 1 mM moxalactam or amoxacillin, the protein carbonyl contents in them were measured by DNPH. RESULTS: Lipid peroxide levels in the uterine venous plasma, umbilical venous plasma, and umbilical arterial plasma of preeclampsia were significantly higher than those of normal pregnancy (3.11+/-1.21 vs. 2.18+/-1.16 nmol/mg protein, p<0.05, 5.85+/-1.67 vs. 3.79+/-1.66 nmol/ mg protein, p<0.01, 6.00+/-1.91 vs. 4.99+/-1.78 nmol/mg protein, p<0.01). Protein carbonyls formation by moxalactam in the uterine venous plasma, umbilical venous plasma, and umbilical arterial plasma of preeclampsia were signigicant higher than those of normal pregnancy (19.69+/-8.43 vs. 10.84+/-3.00 nmol/mg protein, p<0.01, 18.94+/-6.96 vs. 10.63+/-1.81 nmol/mg protein, p<0.01, 14.62+/-5.77 vs. 11.21+/-2.08 nmol/mg protein, p<0.05). There were significant positive correlations between lipid peroxide and moxalactam-induced protein carbonyls levels of the uterine venous plasma, umbilical venous plasma, and umbilical arterial plasma (p<0.01). CONCLUSION: These results suggest that increase in the prooxidative activity stimulating the oxidative modification of proteins in utero-placental unit may be involved in the pathogenesis of preeclampsia.