Pediatric Gastroenterology Department, Yüzüncü Yıl University Medical School, Van, Turkey.
Pediatric Gastroenterology Department, Kırıkkale University Medical School, Kırıkkale, Turkey.
Helicobacter. 2019 Jun;24(3):e12581. doi: 10.1111/hel.12581. Epub 2019 Apr 4.
Helicobacter pylori antimicrobial resistance is gradually increasing around the world. However, there are a limited number of studies reporting on this issue in the pediatric population. In this study, we aimed to determine H pylori resistance to clarithromycin and fluoroquinolones in the pediatric patients living in Kırıkkale province that were detected with H pylori in gastric biopsies. Moreover, we also aimed to investigate the concordance between the histopathologic and molecular methods used in the diagnosis of H pylori infection.
Patients aged 2-18 years who had a history of epigastric pain and/or nausea persisting for longer than 1 month underwent upper gastrointestinal endoscopy. Biopsies were taken from the gastric antral mucosa. In the samples detected with H pylori in the histopathologic examination, the presence of H pylori and H pylori resistance to clarithromycin and fluoroquinolones was investigated using the GenoType HelicoDR test which allows the detection of wild-type and mutant genes. The strains detected with more than one mutant gene are defined as hetero-resistant strains.
The 93 patients that underwent DNA extraction and amplification included 68 (73.1%) girls and 25 (26.9%) boys with a median age of 15 ± 2.62 (range 6-17) years. The overall concordance for the diagnosis of H pylori infection between histopathology and PCR was 94%, and H pylori resistance to clarithromycin and fluoroquinolones was 27% and 15%, respectively.
The high H pylori resistance to clarithromycin and fluoroquinolones among the pediatric patients in our region implicates that the antibiotic sensitivity of strains should be studied prior to administration in accordance with the recommendations provided in the guidelines. Moreover, the presence of hetero-resistant strains in our patients may be a reason for treatment failure.
幽门螺杆菌的抗菌药物耐药性在全球范围内逐渐增加。然而，关于儿科人群中这一问题的研究数量有限。本研究旨在确定在基里卡莱省接受胃镜检查的儿童患者胃活检中检测到的幽门螺杆菌对克拉霉素和氟喹诺酮类药物的耐药性。此外，我们还旨在调查用于诊断幽门螺杆菌感染的组织病理学和分子方法之间的一致性。
年龄在 2-18 岁之间、有上腹痛和/或持续 1 个月以上恶心病史的患者接受上消化道内镜检查。从胃窦黏膜采集活检。在组织病理学检查中检测到幽门螺杆菌的样本中，使用 GenoType HelicoDR 检测试剂盒检测幽门螺杆菌的存在及其对克拉霉素和氟喹诺酮类药物的耐药性，该试剂盒允许检测野生型和突变基因。检测到一个以上突变基因的菌株被定义为异耐药菌株。
93 例患者进行了 DNA 提取和扩增，其中 68 例（73.1%）为女孩，25 例（26.9%）为男孩，中位年龄为 15±2.62 岁（范围 6-17 岁）。组织病理学和 PCR 诊断幽门螺杆菌感染的总体一致性为 94%，幽门螺杆菌对克拉霉素和氟喹诺酮类药物的耐药率分别为 27%和 15%。
本地区儿科患者幽门螺杆菌对克拉霉素和氟喹诺酮类药物的耐药率较高，这提示在根据指南提供的建议进行治疗前，应研究菌株的抗生素敏感性。此外，我们患者中存在异耐药菌株可能是治疗失败的一个原因。
