Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, University of Michigan, 6520A MSRB1, SPC 5682, 1150 West Medical Center Drive, Ann Arbor, MI, 48109, USA.
Dig Dis Sci. 2018 Feb;63(2):437-445. doi: 10.1007/s10620-017-4880-8. Epub 2017 Dec 20.
The current practice guidelines recommend that Helicobacter pylori (H. pylori) culture and antimicrobial susceptibility testing (AST) be considered after patients failed the second course of H. pylori eradication therapy.
Here we report the real life experience of following this recommendation in the USA.
We established an in-house H. pylori culture protocol for AST and identified retrospectively patients who previously failed ≥ 2 courses of anti-H. pylori therapy and underwent esophagogastroduodenoscopy with AST at University of Michigan from 2010 to 2017. We determined the rate of H. pylori antibiotic resistance, the success rates of AST-guided tailored therapy, and the risk factors associated with treatment failure.
Forty-seven patients were identified and 34 (72.3%) had successful cultures and AST. The most common antibiotic resistance was to metronidazole (79.4%), followed by clarithromycin (70.6%) and ciprofloxacin (42.9%). None of the patients were resistant to amoxicillin or tetracycline. The overall success rate of AST-guided tailored therapy was low (44.4%, 12/27). In patients infected with metronidazole-resistant H. pylori, bismuth quadruple therapy appears to be superior compared to non-bismuth quadruple therapy (6/8 or 75.0% vs. 3/14 or 21.4%, P = 0.03). High body mass index was significantly associated with tailored therapy failure (OR 1.24, 95% CI 1.00-1.54, P = 0.049).
The success rate of AST-guided salvage therapy in the USA is low particularly in those with high BMI. Bismuth-based therapy appears to be better than non-bismuth-based regimens.
目前的实践指南建议，在患者第二次幽门螺杆菌（H. pylori）根除治疗失败后，应考虑进行 H. pylori 培养和抗菌药物敏感性检测（AST）。
本研究报告了美国遵循这一建议的真实经验。
我们建立了一种内部 H. pylori 培养和 AST 方案，并回顾性地确定了 2010 年至 2017 年期间在密歇根大学接受过 AST 的既往至少接受过 2 次抗 H. pylori 治疗失败的患者。我们确定了 H. pylori 抗生素耐药率、AST 指导下个体化治疗的成功率以及与治疗失败相关的危险因素。
共确定了 47 例患者，其中 34 例（72.3%）成功培养和进行了 AST。最常见的抗生素耐药性是甲硝唑（79.4%），其次是克拉霉素（70.6%）和环丙沙星（42.9%）。没有患者对阿莫西林或四环素耐药。AST 指导下个体化治疗的总体成功率较低（44.4%，12/27）。在感染甲硝唑耐药 H. pylori 的患者中，铋剂四联疗法似乎优于非铋剂四联疗法（6/8 或 75.0%比 3/14 或 21.4%，P=0.03）。高体质指数与个体化治疗失败显著相关（OR 1.24，95%CI 1.00-1.54，P=0.049）。
AST 指导下的补救治疗在美国的成功率较低，尤其是在 BMI 较高的患者中。铋剂为基础的治疗方案似乎优于非铋剂方案。
