Dargiene Gintare, Kupcinskas Juozas, Jonaitis Laimas, Vezbavicius Mindaugas, Kadusevicius Edmundas, Kupcinskiene Eugenija, Frandsen Tove Havnhoj, Kucinskiene Ruta, Kupcinskas Limas, Andersen Leif Percival
Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
APMIS. 2018 Jan;126(1):21-28. doi: 10.1111/apm.12752. Epub 2017 Nov 13.
The study evaluated primary antibiotic resistance of Helicobacter pylori within the period 2013-2015 and trends of antibiotic consumption over the last decade in Lithuania; 242 adults and 55 children were included in the study. E-tests were performed for amoxicillin, metronidazole, clarithromycin, ciprofloxacin, rifampicin and tetracycline. The presence of H. pylori and clarithromycin resistance was additionally tested by PCR. Helicobacter pylori culture was positive in 67 of 242 (28%) adult and in 12 of 55 (21.8%) children samples. Resistance rates among adults by E-tests were as follows: metronidazole - 32.8% (95% confidence interval (CI): 22.7-44.7%), ciprofloxacin - 7.5% (95% CI: 3.2-16.3%), rifampicin - 7.5% (95% CI: 3.2-16.3%), amoxicillin - 0%, whereas resistance rates in children were as follows: metronidazole - 25% (95% CI: 8.9-53.2%), rifampicin - 8.3% (CI: 1.5-35.4%), amoxicillin and ciprofloxacin - 0%. Accumulated clarithromycin resistance rates by E-tests and PCR were 8.2% (95% CI: 4.1-16.0%) in adults and 17.7% (95% CI: 6.2-41.0%) in children. Total use of macrolides and lincosamides in Lithuania increased from 1.26 to 1.86 defined daily dose (DDD)/1000 inhabitants/day among adults, while it has doubled from 1.10 to 2.22 DDD/1000/children/day in children within 2003-2015. There are no significant changes in the susceptibility of H. pylori to the most widely used antibiotics in adults over the last years in Lithuania; however, clarithromycin resistance among children exceeds 15% and mandates further larger-scale studies in paediatric population.
该研究评估了2013 - 2015年期间立陶宛幽门螺杆菌的主要抗生素耐药性以及过去十年抗生素的消费趋势；共有242名成人和55名儿童参与了该研究。对阿莫西林、甲硝唑、克拉霉素、环丙沙星、利福平和四环素进行了E试验。另外通过聚合酶链反应（PCR）检测幽门螺杆菌和克拉霉素耐药性的存在情况。在242份成人样本中，67份（28%）幽门螺杆菌培养呈阳性，在55份儿童样本中，12份（21.8%）呈阳性。通过E试验得出的成人耐药率如下：甲硝唑 - 32.8%（95%置信区间（CI）：22.7 - 44.7%），环丙沙星 - 7.5%（95% CI：3.2 - 16.3%），利福平 - 7.5%（95% CI：3.2 - 16.3%），阿莫西林 - 0%；而儿童的耐药率如下：甲硝唑 - 25%（95% CI：8.9 - 53.2%），利福平 - 8.3%（CI：1.5 - 35.4%），阿莫西林和环丙沙星 - 0%。通过E试验和PCR得出的成人累积克拉霉素耐药率为8.2%（95% CI：4.1 - 16.0%），儿童为17.7%（95% CI：6.2 - 41.0%）。2003 - 2015年期间，立陶宛成人中大环内酯类和林可酰胺类药物的总使用量从1.26限定日剂量（DDD）/1000居民/天增加到1.86 DDD/1000居民/天，而儿童中的使用量从1.10 DDD/1000儿童/天增加了一倍，达到2.22 DDD/1000儿童/天。在过去几年中，立陶宛成人中幽门螺杆菌对最常用抗生素的敏感性没有显著变化；然而，儿童中的克拉霉素耐药率超过15%，这需要在儿科人群中进行进一步的大规模研究。
