Boyanova Lyudmila, Ilieva Juliana, Gergova Galina, Spassova Zoya, Nikolov Rossen, Davidkov Lubomir, Evstatiev Ivailo, Kamburov Victor, Katsarov Nikolai, Mitov Ivan
Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria.
University Department of Social Medicine and Healthcare Management, Medical University of Sofia, Sofia, Bulgaria.
J Med Microbiol. 2009 Jan;58(Pt 1):94-100. doi: 10.1099/jmm.0.003855-0.
The aim of this study was to assess the clinical and socio-demographic risk factors for primary Helicobacter pylori antibacterial resistance. In total, 266 consecutive H. pylori strains, from untreated symptomatic adult patients who answered a questionnaire, were evaluated. Strain susceptibility to amoxicillin, metronidazole, clarithromycin and tetracycline was tested by a breakpoint susceptibility test. Metronidazole resistance was found in fewer (17.0 %) peptic ulcer patients than in non-ulcer subjects (28.3 %, P=0.037), as well as in fewer patients born in villages (12.7 %) than in those born in towns (27.6 %, P=0.016). Clarithromycin resistance varied from 8.8 to 23.4 % (P=0.009) within the hospital centres. The highest clarithromycin resistance rate was found in hospital centre A (23.4 %) compared to other centres (12.9 %, P=0.041). The factors sex, age, symptom duration, non-steroidal anti-inflammatory drug use, diabetes, type of profession and educational level were not associated with H. pylori resistance. Logistic regression revealed that the risk factors for metronidazole resistance were non-ulcer disease [odds ratio (OR) 1.95, 95 % confidence interval (95 % CI) 1.04-3.65] and a birthplace of a town (OR 2.64, 95 % CI 1.18-5.93). The hospital centre may be a risk factor (OR 2.07, 95 % CI 1.02-4.21) for clarithromycin resistance but further studies are required to verify this suggestion. In conclusion, the knowledge of the risk factors for H. pylori resistance to antibacterials could facilitate the treatment choice for H. pylori eradication.
本研究旨在评估原发性幽门螺杆菌对抗菌药物耐药性的临床及社会人口统计学风险因素。总共对266株来自未接受治疗且有症状的成年患者的连续幽门螺杆菌菌株进行了评估，这些患者均回答了一份问卷。通过断点药敏试验检测菌株对阿莫西林、甲硝唑、克拉霉素和四环素的敏感性。发现甲硝唑耐药在消化性溃疡患者中（17.0%）少于非溃疡患者（28.3%，P = 0.037），在出生于农村的患者中（12.7%）也少于出生于城镇的患者（27.6%，P = 0.016）。医院各中心的克拉霉素耐药率在8.8%至23.4%之间（P = 0.009）。与其他中心（12.9%）相比，医院中心A的克拉霉素耐药率最高（23.4%，P = 0.041）。性别、年龄、症状持续时间、非甾体抗炎药使用情况、糖尿病、职业类型和教育水平等因素与幽门螺杆菌耐药性无关。逻辑回归分析显示，甲硝唑耐药的风险因素是非溃疡疾病[比值比（OR）1.95，95%置信区间（95%CI）1.04 - 3.65]和出生于城镇（OR 2.64，95%CI 1.18 - 5.93）。医院中心可能是克拉霉素耐药的一个风险因素（OR 2.07，95%CI 1.02 - 4.21），但需要进一步研究来验证这一观点。总之，了解幽门螺杆菌对抗菌药物耐药的风险因素有助于为幽门螺杆菌根除治疗选择合适的方案。
