重庆地区2015～2017年幽门螺杆菌耐药性分析
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摘要
目的分析重庆地区幽门螺杆菌(Hp)耐药情况。方法收集2015年1月～2017年12月在重庆市大坪医院行胃镜检查患者的胃黏膜标本14882例,进行Hp分离培养,并采用琼脂稀释法对Hp进行药敏试验,对药敏结果进行统计学分析。结果分离培养Hp阳性菌株3841株,培养阳性率25.81%,男性培养阳性率高于女性(P<0.05)。Hp对甲硝唑、克拉霉素、左氧氟沙星、阿莫西林总的耐药率分别为94.09%、26.30%、33.98%、0.26%,未发现对四环素及呋喃唑酮耐药。重庆地区2015～2017年Hp对甲硝唑、克拉霉素、左氧氟沙星的耐药率上升(P<0.05);女性对克拉霉素、左氧氟沙星耐药率均高于男性(P<0.05);随着年龄的增长,人群对甲硝唑和左氧氟沙星耐药率呈上升趋势,不同年龄段人群对克拉霉素耐药率比较差异无统计学意义(P>0.05)。结论重庆地区Hp对甲硝唑、克拉霉素、左氧氟沙星的耐药率均较高,临床工作者应根据药敏结果选择个体化治疗方案,或者采用含阿莫西林、四环素、呋喃唑酮或甲硝唑的铋剂四联疗法行经验性治疗。
Objective To investigate and analyze the prevalence of Helicobacter pylori antibiotic resistance.Methods The antibiotic resistance of H. pylori strains isolated from 14882 gastric biopsies of patients inspected at Daping Hospital from January 2015 to December 2017 was assessed by agar dilution method,and statistical analysis was performed on the results of drug sensitivity. Results 3841 Helicobacter pylori strains were isolated. The positive rate of isolated culture was 25.81%. The male positive rate was significantly higher than female positive rate(P<0.05). The resistance rates to metronidazole,clarithromycin, levofloxacin and amoxicillin were 94.09%,26.30%, 33.98% and 0.26%, respectively. No resistance to furazolidone or tetracycline was observed. When comparing with those in the past three years, the antibiotic resistance rates to metronidazole,clarithromycin and levofloxacin were increased from 88.97%,22.41%, 21.72% to 96.88%,25.87%, 36.83%(P<0.05). Higher resistance to clarithromycin and levofloxacin were observed in female patients. As the growth of the age, we also noted a remarkable rise in metronidazole resistance and levofloxacin resistance. No difference of resistance to clarithromycin was observed among various age groups. Conclusion The prevalence of Hp resistance to clarithromycin, metronidazole and levofloxacin in Chongqing is high. Choice of therapy should be individualized based on a susceptibilitytest in this region, or bismuth-containing quadruple therapies with a combination of alternative antibiotics(eg, amoxicillin, tetracycline, furazolidone or metronidazole) for empiric treatment should be recommended.
Objective To investigate and analyze the prevalence of Helicobacter pylori antibiotic resistance.Methods The antibiotic resistance of H. pylori strains isolated from 14882 gastric biopsies of patients inspected at Daping Hospital from January 2015 to December 2017 was assessed by agar dilution method,and statistical analysis was performed on the results of drug sensitivity. Results 3841 Helicobacter pylori strains were isolated. The positive rate of isolated culture was 25.81%. The male positive rate was significantly higher than female positive rate(P<0.05). The resistance rates to metronidazole,clarithromycin, levofloxacin and amoxicillin were 94.09%,26.30%, 33.98% and 0.26%, respectively. No resistance to furazolidone or tetracycline was observed. When comparing with those in the past three years, the antibiotic resistance rates to metronidazole,clarithromycin and levofloxacin were increased from 88.97%,22.41%, 21.72% to 96.88%,25.87%, 36.83%(P<0.05). Higher resistance to clarithromycin and levofloxacin were observed in female patients. As the growth of the age, we also noted a remarkable rise in metronidazole resistance and levofloxacin resistance. No difference of resistance to clarithromycin was observed among various age groups. Conclusion The prevalence of Hp resistance to clarithromycin, metronidazole and levofloxacin in Chongqing is high. Choice of therapy should be individualized based on a susceptibilitytest in this region, or bismuth-containing quadruple therapies with a combination of alternative antibiotics(eg, amoxicillin, tetracycline, furazolidone or metronidazole) for empiric treatment should be recommended.
引文
[1] Hooi JKY ,Lai WY ,Ng WK ,et al.Global Prevalence of Helicobacter pylori Infection:Systematic Review and Meta-analysis[J].Gastroenterology,2017:153(2):420-429.
[2] Bottin-Rousseau S,Akamatsu S,Faivre G.A national study of Helicobactor pylori infection in gastric biopsy specimens[J].Gastroenterology,2010,139(6):1894-1901.
[3] Sipponen,P.Natural History of Gastritis and its Relationship to Peptic Ulcer Disease[J].Digestion,1992,51(1):70-75.
[4] Moayyedi P ,Forman D ,Braunholtz D ,et al.The proportion of upper gastrointestinal symptoms in the community associated with helicobacter pylori,lifestyle factors,and nonsteroidal anti-inflammatory drugs[J].American Journal of Gastroenterology,2000,95(6):1448-1455.
[5] Sugano K .Screening of gastric cancer in Asia[J].Best Pract Res Clin Gastroenterol,2015,29(6):895-905.
[6] Graham DY ,Fischbach L .Helicobacter pylori treatment in the era of increasing antibiotic resistance[J].Gut,2010,59(8):1143-1153.
[7] Clinical and Laboratory Standards Institute.Nineteenth Informational Supplement M100-S19,A07[S].Performance Standards for Antimicrobial Susceptibility Testing,2009:M100-S19.
[8] Sugano K ,Tack J ,Kuipers EJ ,et al.Kyoto global consensus report on Helicobacter pylori gastritis[J].Gut,2015,64(9):1353-1367.
[9] MalfertheinerP ,Megraud F ,O'Morain CA .Management of helicobacter pylori infection-the maastricht v/florence consensus report[J].Gut,2017,66:6-30.
[10] SavoldiA ,Carrara E ,Graham DY ,et al.Prevalence of Antibiotic Resistance in Helicobacter pylori:A Systematic Review and Meta-Analysis in World Health Organization Regions[J].Gastroenterology,2018,155(5),1372-1382.
[11] 牛占岳,宋志强,周丽雅.中国大陆地区成人幽门螺杆菌耐药情况及变迁[J].中华内科杂志,2016,55(9):9.
[12] 刘文忠,谢勇,陆红,等.第五次全国幽门螺杆菌感染处理共识报告[J].胃肠病学,2017,22(6):346-360.
[13] Ran H ,Hong L ,Ming-Wan J ,et al.Multicenter Study of Antibiotic Resistance Profile of,H.pylori,and Distribution of CYP2C19 Gene Polymorphism in Rural Population of Chongqing,China[J].Gastroenterology Research and Practice,2016,2016:1-6.
[14] Mégraud F.H pylori antibiotic resistance:prevalence,importance,and advances in testing[J].Gut,2004,53(9):1374-1384.
[15] Benzvi H.Epidemiology and mechanism of antibiotic resistance in Helicobacter pylori[J].Gastroenterology,1998,115(5):1278-1282.
[16] Hospital H ,Citationformats.Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption[J].Gastroenterology,2013,62(1):34-42.
[17] Liou JM ,Wu JY ,Chang CY ,et al.Su1929 The Primary Resistance of Helicobacter pylori in Taiwan After the National Policy to Restrict Antibiotic Consumption and Its Relation to Virulence Factors-A Nationwide Study[J].PLoS One,2015,10(5),e124199.
[18] VanBoeckel TP ,Gandra S ,Ashok A ,et al.Global antibiotic consumption 2000 to 2010:an analysis of national pharmaceutical sales data.[J].Lancet Infectious Diseases,2014,14(8):742-750.
[19] Kuo YT,Liou JM,El-Omar EM ,et al.Primary antibiotic resistance in Helicobacter pylori in the Asia-Pacificregion:a systematic review and meta-analysis[J].The Lancet Gastroenterology & Hepatology,2017,2(10),707-715.
[20] 陈秋玲,林朗,方优红,等.2009-2014年浙江省苍南县就医患者幽门螺杆菌耐药性分析[J].中华微生物学和免疫学杂志,2015,35(6):427-428.
[21] Meyer JM ,Silliman NP ,Wang W ,et al.Risk Factors for Helicobacter pylori Resistance in the United States:The Surveillance of H.pylori Antimicrobial Resistance Partnership (SHARP) Study,1993-1999[J].Annals of Internal Medicine,2002,136(1):13-24.
[22] Liu G ,Xu X ,He L ,et al.Primary Antibiotic Resistance of Helicobacter pylori Isolated from Beijing Children[J].Helicobacter,2011,16(5):356-362.
[2] Bottin-Rousseau S,Akamatsu S,Faivre G.A national study of Helicobactor pylori infection in gastric biopsy specimens[J].Gastroenterology,2010,139(6):1894-1901.
[3] Sipponen,P.Natural History of Gastritis and its Relationship to Peptic Ulcer Disease[J].Digestion,1992,51(1):70-75.
[4] Moayyedi P ,Forman D ,Braunholtz D ,et al.The proportion of upper gastrointestinal symptoms in the community associated with helicobacter pylori,lifestyle factors,and nonsteroidal anti-inflammatory drugs[J].American Journal of Gastroenterology,2000,95(6):1448-1455.
[5] Sugano K .Screening of gastric cancer in Asia[J].Best Pract Res Clin Gastroenterol,2015,29(6):895-905.
[6] Graham DY ,Fischbach L .Helicobacter pylori treatment in the era of increasing antibiotic resistance[J].Gut,2010,59(8):1143-1153.
[7] Clinical and Laboratory Standards Institute.Nineteenth Informational Supplement M100-S19,A07[S].Performance Standards for Antimicrobial Susceptibility Testing,2009:M100-S19.
[8] Sugano K ,Tack J ,Kuipers EJ ,et al.Kyoto global consensus report on Helicobacter pylori gastritis[J].Gut,2015,64(9):1353-1367.
[9] MalfertheinerP ,Megraud F ,O'Morain CA .Management of helicobacter pylori infection-the maastricht v/florence consensus report[J].Gut,2017,66:6-30.
[10] SavoldiA ,Carrara E ,Graham DY ,et al.Prevalence of Antibiotic Resistance in Helicobacter pylori:A Systematic Review and Meta-Analysis in World Health Organization Regions[J].Gastroenterology,2018,155(5),1372-1382.
[11] 牛占岳,宋志强,周丽雅.中国大陆地区成人幽门螺杆菌耐药情况及变迁[J].中华内科杂志,2016,55(9):9.
[12] 刘文忠,谢勇,陆红,等.第五次全国幽门螺杆菌感染处理共识报告[J].胃肠病学,2017,22(6):346-360.
[13] Ran H ,Hong L ,Ming-Wan J ,et al.Multicenter Study of Antibiotic Resistance Profile of,H.pylori,and Distribution of CYP2C19 Gene Polymorphism in Rural Population of Chongqing,China[J].Gastroenterology Research and Practice,2016,2016:1-6.
[14] Mégraud F.H pylori antibiotic resistance:prevalence,importance,and advances in testing[J].Gut,2004,53(9):1374-1384.
[15] Benzvi H.Epidemiology and mechanism of antibiotic resistance in Helicobacter pylori[J].Gastroenterology,1998,115(5):1278-1282.
[16] Hospital H ,Citationformats.Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption[J].Gastroenterology,2013,62(1):34-42.
[17] Liou JM ,Wu JY ,Chang CY ,et al.Su1929 The Primary Resistance of Helicobacter pylori in Taiwan After the National Policy to Restrict Antibiotic Consumption and Its Relation to Virulence Factors-A Nationwide Study[J].PLoS One,2015,10(5),e124199.
[18] VanBoeckel TP ,Gandra S ,Ashok A ,et al.Global antibiotic consumption 2000 to 2010:an analysis of national pharmaceutical sales data.[J].Lancet Infectious Diseases,2014,14(8):742-750.
[19] Kuo YT,Liou JM,El-Omar EM ,et al.Primary antibiotic resistance in Helicobacter pylori in the Asia-Pacificregion:a systematic review and meta-analysis[J].The Lancet Gastroenterology & Hepatology,2017,2(10),707-715.
[20] 陈秋玲,林朗,方优红,等.2009-2014年浙江省苍南县就医患者幽门螺杆菌耐药性分析[J].中华微生物学和免疫学杂志,2015,35(6):427-428.
[21] Meyer JM ,Silliman NP ,Wang W ,et al.Risk Factors for Helicobacter pylori Resistance in the United States:The Surveillance of H.pylori Antimicrobial Resistance Partnership (SHARP) Study,1993-1999[J].Annals of Internal Medicine,2002,136(1):13-24.
[22] Liu G ,Xu X ,He L ,et al.Primary Antibiotic Resistance of Helicobacter pylori Isolated from Beijing Children[J].Helicobacter,2011,16(5):356-362.