Department of Medical 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. 2012 Jan;61(Pt 1):85-93. doi: 10.1099/jmm.0.035568-0. Epub 2011 Aug 26.
The aim of this study was to assess risk factors for primary Helicobacter pylori antibiotic resistance by an extended anamnesis. In total, 519 H. pylori strains from untreated symptomatic adults who answered a questionnaire were evaluated. Strain susceptibility was assessed by a breakpoint susceptibility test. Primary resistance rates were 29.5 % for metronidazole, 17.9 % for clarithromycin, 7.3 % for metronidazole+clarithromycin, 4.0 % for tetracycline and 10.8 % for ciprofloxacin. On multivariate analysis, younger (≤65 years) age was an independent predictor for metronidazole resistance. To our knowledge, for the first time, being a member of the health-care profession was revealed as a risk factor for H. pylori resistance to metronidazole and both metronidazole and clarithromycin. Respiratory and urinary tract infections were independent predictors of clarithromycin and ciprofloxacin resistance, respectively. The presence of co-infections was an independent risk factor for clarithromycin, metronidazole and ciprofloxacin resistance. Surprisingly, female sex was the only predictor for tetracycline resistance. The antibiotic resistance rates were not associated with disease type, place of residence, birthplace, educational level, non-steroidal anti-inflammatory drug or proton pump inhibitor use, smoking or dietary factors, such as consumption of coffee, yogurt, green tea, raw garlic, raw onion, honey or meat. There was a trend for higher metronidazole resistance in strains from diabetic patients. In conclusion, the extended anamnesis of H. pylori-positive patients should include data on patient age, sex, whether they are in the health-care profession, co-infections and possibly diabetes to improve the choice of empiric therapy. Tailored treatment based on the extended anamnesis is suggested, and susceptibility testing of the strains is recommended for patients at risk for antibiotic resistance, especially to clarithromycin, fluoroquinolones or both metronidazole and clarithromycin.
本研究旨在通过扩展的病史评估原发性幽门螺杆菌抗生素耐药的危险因素。总共评估了 519 株来自未经治疗的有症状成年人的幽门螺杆菌菌株，这些成年人回答了一份问卷。通过断点药敏试验评估菌株的药敏性。主要耐药率分别为甲硝唑 29.5%、克拉霉素 17.9%、甲硝唑+克拉霉素 7.3%、四环素 4.0%、环丙沙星 10.8%。多变量分析显示，年龄≤65 岁是甲硝唑耐药的独立预测因素。据我们所知，作为医疗保健专业人员首次被揭示为幽门螺杆菌对甲硝唑和甲硝唑+克拉霉素耐药的危险因素。呼吸道和尿路感染分别是克拉霉素和环丙沙星耐药的独立预测因素。合并感染的存在是克拉霉素、甲硝唑和环丙沙星耐药的独立危险因素。令人惊讶的是，女性是四环素耐药的唯一预测因素。抗生素耐药率与疾病类型、居住地、出生地、教育水平、非甾体抗炎药或质子泵抑制剂使用、吸烟或饮食因素（如咖啡、酸奶、绿茶、生大蒜、生洋葱、蜂蜜或肉类的摄入）无关。糖尿病患者的甲硝唑耐药率呈上升趋势。总之，幽门螺杆菌阳性患者的扩展病史应包括患者年龄、性别、是否从事医疗保健行业、合并感染以及可能的糖尿病等数据，以改善经验性治疗的选择。建议根据扩展的病史进行个体化治疗，并建议对有抗生素耐药风险的患者进行菌株药敏试验，尤其是对克拉霉素、氟喹诺酮类药物或甲硝唑和克拉霉素联合耐药的患者。
