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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 934-938. doi: 10.19723/j.issn.1671-167X.2023.05.024

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Comparison of Epsilometer test and agar dilution method in detecting the sensitivity of Helicobacter pylori to metronidazole

Xue-li TIAN,Zhi-qiang SONG*(),Bao-jun SUO,Li-ya ZHOU,Cai-ling LI,Yu-xin ZHANG   

  1. Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-07-01 Online:2023-10-18 Published:2023-10-09
  • Contact: Zhi-qiang SONG E-mail:18910192576@163.com
  • Supported by:
    the National Natural Science Foundation of China(81670605);the Clinical Key Projects of Peking University Third Hospital(BYSY2018008)

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Abstract:

Objective: Agar dilution method (ADM) was used as the golden standard to evaluate the consistency of Epsilometer test (E-test) in detecting the sensitivity of Helicobacter pylori (H. pylori) to metronidazole. Methods: From August 2018 to July 2020, patients with H. pylori infection treated for the first time in Peking University Third Hospital for gastroscopy due to dyspepsia were included in this study. Gastric mucosas were taken from the patients with H. pylori infection. H. pylori culture was performed. Both the ADM and E-test were applied to the antibiotic susceptibility of H. pylori to metro-nidazole, and the consistency and correlation between the two methods were validated. Results: In the study, 105 clinical isolates of H. pylori were successfully cultured, and the minimum inhibitory concentration ≥ 8 mg/L was defined as drug resistance. Both ADM and the E-test showed high resistance rates to metronidazole, 64.8% and 62.9%, respectively. Among them, 66 drug-resistant strains were detected by ADM and E-test, and 37 were sensitive strains, so the consistency rate was 98.1%. Two strains were evaluated as drug resistance by ADM, but sensitive by the E-test, with a very major error rate of 1.9%. There was zero strain sensitive according to ADM but assessed as resistant by the E-test, so the major error rate was 0%. Taking ADM as the gold standard, the sensitivity of E-test in the detection of metronidazole susceptibility was 97.1% (95%CI: 0.888-0.995), and the specificity was 100% (95%CI: 0.883-1.000). Cohen's kappa analysis showed substantial agreement, and kappa coefficient was 0.959 (95%CI: 0.902-1.016, P < 0.001). Spearmans correlation analysis confirmed this correlation was significant (r=0.807, P < 0.001). The consistency evaluation of Bland-Altman method indicated that it was good, and there was no measured value outside the consistency interval. In this study, cost analysis, including materials and labor, showed a 32.2% higher cost per analyte for ADM as compared with the E-test (356.6 yuan vs. 269.8 yuan). Conclusion: The susceptibility test of H. pylori to metronidazole by E-test presents better agreement with ADM. Because it is less expensive, less labor intensive, and more rapid, it is an easy and reliable method for H. pylori susceptibility testing.

Key words: Epsilometer test, Agar dilution count, Helicobacter pylori, Microbial sensitivity tests

CLC Number: 

  • R446.5

Figure 1

Evaluation of the consistency of ADM and E-test in detecting MIC of metronidazole by Bland-Altman method ADM, agar dilution method; E-test, Epsilometer test; MIC, minimal inhibitory concentration; SD, standard deviation."

Table 1

Cost analysis of one case of metronidazole susceptibility test by ADM and E-test"

E-test ADM
Unit-price/yuan n Total/yuan Unit-price/yuan n Total/yuan
E-test strip 35.0 1 35.0 -
Agar dilution plate (11 gradients) - 8.8 11 96.8
Plate (containing antibiotics) 12.0 2 24.0 12.0 2 24.0
Plate (without antibiotics) 8.8 4 35.2 8.8 4 35.2
General culture plate 25.0 2 50.0 25.0 2 50.0
Nitrogen, water and electricity 60.0 1 60.0 60.0 1 60.0
Manual labor 50.0 1 50.0 75.0 1 75.0
Others 15.6 15.6
Total 269.8 356.6
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