Meyer Joette M, Silliman Nancy P, Wang Wenjin, Siepman Nancy Y, Sugg Jennifer E, Morris David, Zhang Jie, Bhattacharyya Helen, King Eileen C, Hopkins Robert J
Division of Drug Evaluation III (HFD-880), 9201 Corporate Boulevard, Room S-402, Rockville, MD 20850, USA.
Ann Intern Med. 2002 Jan 1;136(1):13-24. doi: 10.7326/0003-4819-136-1-200201010-00008.
Pretreatment antimicrobial resistance has an important impact on the efficacy of many Helicobacter pylori treatment regimens.
To estimate the prevalence of H. pylori resistance to antimicrobials in the United States, to characterize risk factors associated with H. pylori antimicrobial resistance, and to explore the association between drug utilization and antimicrobial resistance patterns over time.
Meta-analysis using patient-level data.
20 nationwide trials of H. pylori eradication.
3624 men and women, each of whom contributed one isolate.
Rates of H. pylori resistance to clarithromycin, metronidazole, and amoxicillin, according to geographic region, age, sex, study year, ethnicity, ulcer status, test method, and study.
Overall resistance to clarithromycin, metronidazole, and amoxicillin was 10.1% (95% CI, 9.1% to 11.1% [360 of 3571 patients]), 36.9% (CI, 35.1% to 38.7% [1063 of 2883 patients]), and 1.4% (CI, 1.0% to 1.8% [48 of 3486 patients]), respectively. In multivariable analyses, multiple risk factors were associated with resistance to individual agents. Clarithromycin resistance was significantly associated with geographic region (P = 0.050), older age (P < 0.001), female sex (P < 0.001), inactive ulcer disease (P < 0.001), and study (P = 0.010). Metronidazole resistance was significantly associated with female sex (P < 0.001), earlier year of study enrollment (P = 0.036), Asian ethnicity (P < 0.001), use of an epsilometer test (P = 0.002), and study (P < 0.001). Amoxicillin resistance was low and was not significantly associated with any risk factor. In the 1990s, when rates for use of oral macrolides and metronidazole were relatively stable, clarithromycin resistance rates were stable and metronidazole resistance rates varied.
Clinicians should consider risk factors for antimicrobial resistance when deciding which patients should have susceptibility testing and when choosing appropriate H. pylori treatments in the empirical setting.
治疗前的抗菌药物耐药性对许多幽门螺杆菌治疗方案的疗效有重要影响。
评估美国幽门螺杆菌对抗菌药物的耐药率，确定与幽门螺杆菌抗菌药物耐药性相关的危险因素，并探讨药物使用情况与抗菌药物耐药模式随时间的关联。
使用患者层面数据的荟萃分析。
20项全国性幽门螺杆菌根除试验。
3624名男性和女性，每人提供一份分离株。
根据地理区域、年龄、性别、研究年份、种族、溃疡状态、检测方法和研究，幽门螺杆菌对克拉霉素、甲硝唑和阿莫西林的耐药率。
对克拉霉素、甲硝唑和阿莫西林的总体耐药率分别为10.1%（95%CI，9.1%至11.1%[3571例患者中的360例]）、36.9%（CI，35.1%至38.7%[2883例患者中的1063例]）和1.4%（CI，1.0%至1.8%[3486例患者中的48例]）。在多变量分析中，多个危险因素与个体药物的耐药性相关。克拉霉素耐药性与地理区域（P = 0.050）、年龄较大（P < 0.001）、女性（P < 0.001）、非活动性溃疡疾病（P < 0.001）和研究（P = 0.010）显著相关。甲硝唑耐药性与女性（P < 0.001）、较早的研究入组年份（P = 0.036）、亚洲种族（P < 0.001）、使用埃普西隆计试验（P = 0.002）和研究（P < 0.001）显著相关。阿莫西林耐药性较低，与任何危险因素均无显著关联。在20世纪90年代，口服大环内酯类药物和甲硝唑的使用率相对稳定，克拉霉素耐药率稳定，甲硝唑耐药率有所变化。
临床医生在决定哪些患者应进行药敏试验以及在经验性治疗中选择合适的幽门螺杆菌治疗方案时，应考虑抗菌药物耐药性的危险因素。
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