Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, 4055 Tudor Centre Dr., Anchorage, AK 99508, USA.
Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, 4055 Tudor Centre Dr., Anchorage, AK 99508, USA.
J Glob Antimicrob Resist. 2018 Dec;15:148-153. doi: 10.1016/j.jgar.2018.06.016. Epub 2018 Jun 30.
Alaska Natives experience a high burden of Helicobacter pylori infection and concomitant high rates of gastric cancer. Additionally, the prevalence of antimicrobial-resistant H. pylori has been shown to be high in Alaska. In this study, antimicrobial resistance over time among sentinel surveillance isolates was evaluated and risk factors for carrying antimicrobial-resistant H. pylori were assessed.
Through Alaska's H. pylori sentinel surveillance system, antral and fundal biopsies from Alaska Native patients undergoing esophagogastroduodenoscopy for clinical indications during 2000-2016 were collected and cultured. For positive cultures, minimum inhibitory concentrations (MICs) of metronidazole, amoxicillin, clarithromycin, tetracycline and levofloxacin were determined.
A total of 800 H. pylori isolates obtained from 763 patients were tested. Resistance to metronidazole was most common (342/800; 42.8%), followed clarithromycin (238/800; 29.8%), both clarithromycin and metronidazole (128/800; 16.0%) and levofloxacin (113/800; 14.1%). Low proportions of isolates were resistant to amoxicillin and tetracycline. Levofloxacin resistance increased between 2000 and 2016 (P<0.001), but resistance to other antimicrobials did not change over time. Metronidazole and clarithromycin resistance were more common among women (P<0.001 for both), whilst levofloxacin resistance was more common among those with an urban residence (P=0.003). Metronidazole and levofloxacin resistance were more common among older patients (P<0.05).
Between 2000 and 2016, a large percentage of H. pylori isolates received by the Alaska Sentinel Surveillance System demonstrated resistance to common antimicrobials. The surveillance system provides valuable information for clinicians to make informed treatment choices for patient with H. pylori.
阿拉斯加原住民感染幽门螺杆菌的负担很重，胃癌的发病率也很高。此外，在阿拉斯加，已经证实幽门螺杆菌对抗生素的耐药率很高。本研究评估了一段时间内哨兵监测分离株的抗生素耐药性，并评估了携带抗生素耐药性幽门螺杆菌的危险因素。
通过阿拉斯加的幽门螺杆菌哨兵监测系统，收集并培养了 2000 年至 2016 年间因临床指征接受食管胃十二指肠镜检查的阿拉斯加原住民患者的胃窦和胃底活检。对于阳性培养物，测定了甲硝唑、阿莫西林、克拉霉素、四环素和左氧氟沙星的最低抑菌浓度（MIC）。
共检测了 763 名患者的 800 株幽门螺杆菌分离株。对甲硝唑的耐药性最常见（342/800；42.8%），其次是克拉霉素（238/800；29.8%），克拉霉素和甲硝唑联合耐药（128/800；16.0%）和左氧氟沙星（113/800；14.1%）。对阿莫西林和四环素的耐药率较低。左氧氟沙星的耐药性在 2000 年至 2016 年间有所增加（P<0.001），但其他抗生素的耐药性并未随时间而改变。甲硝唑和克拉霉素的耐药性在女性中更为常见（P<0.001），而左氧氟沙星的耐药性在城市居民中更为常见（P=0.003）。甲硝唑和左氧氟沙星的耐药性在老年患者中更为常见（P<0.05）。
在 2000 年至 2016 年期间，阿拉斯加哨兵监测系统收到的大量幽门螺杆菌分离株对常见抗生素表现出耐药性。该监测系统为临床医生为幽门螺杆菌患者做出明智的治疗选择提供了有价值的信息。
