School of Medicine, Kyungpook National University, Daegu, South Korea.
Department of Internal medicine, Kyungpook National University Hospital, Daegu, South Korea.
Helicobacter. 2019 Aug;24(4):e12585. doi: 10.1111/hel.12585. Epub 2019 Apr 10.
As the prevalence of antibiotic resistance is increasing, the effectiveness of traditional Helicobacter pylori (H pylori) therapies is gradually declining. We aimed to evaluate the efficacy of tailored therapy (dual priming oligonucleotide [DPO]-based multiplex PCR) and previous antibiotic exposure survey predicting for antibiotic resistance.
Patients with H pylori infection who did not receive previous treatment were enrolled. The patients were divided into four groups (no resistance [NR] group, clarithromycin resistance [CLA-R] group, metronidazole-resistant [MET-R] group, and CLA- and MET-resistant [Dual-R] group) based on the results of dual priming oligonucleotide (DPO) polymerase chain reaction (PCR) and previous antibiotic exposure survey, and they were treated with tailored therapy based on antibiotic susceptibility.
Consecutive patients were distributed in the NR (n = 36, 70.6%), CLA-R (n = 9, 17.6%), and suspected MET-R (n = 6, 11.8%) group. The overall intention-to-treat/per-protocol eradication rate (ITT/PP) was 92.2%/94.0%. In the subgroup analysis, the ITT and PP of the NR, CLA-R, and MET-R groups were 94.4%/94.4%, 77.8%/87.5%, and 100.0%/100.0%, respectively. Total of 31 patients in all subgroups were evaluated for antibiotic resistance; five (16.1%), two (6.5%), and three (9.7%) participants showed CLA, MET, and dual resistance in culture-based susceptibility test. Compared with culture-based MIC test, the accuracy of DPO-based multiplex PCR in determining CLA resistance was 90.3%, while the accuracy of survey in determining MET resistance was only 77.4%.
A tailored therapy based on DPO-PCR and history of previous antibiotic use is useful in clinical practice and well correlated with culture-based susceptibility test.
随着抗生素耐药性的流行率不断上升，传统的幽门螺杆菌（H.pylori）治疗的效果逐渐下降。本研究旨在评估基于靶向治疗（基于双重引物寡核苷酸[DPO]的多重 PCR）和既往抗生素暴露调查预测抗生素耐药性的疗效。
本研究纳入了未接受过治疗的 H.pylori 感染患者。根据双重引物寡核苷酸（DPO）聚合酶链反应（PCR）和既往抗生素暴露调查的结果，将患者分为 4 组（无耐药[NR]组、克拉霉素耐药[CLA-R]组、甲硝唑耐药[MET-R]组和 CLA 和 MET 耐药[Dual-R]组），并根据抗生素敏感性进行靶向治疗。
连续患者被分配到 NR（n=36，70.6%）、CLA-R（n=9，17.6%）和疑似 MET-R（n=6，11.8%）组。总的意向治疗/方案根除率（ITT/PP）为 92.2%/94.0%。在亚组分析中，NR、CLA-R 和 MET-R 组的 ITT 和 PP 分别为 94.4%/94.4%、77.8%/87.5%和 100.0%/100.0%。所有亚组中共有 31 名患者接受了抗生素耐药性评估；5（16.1%）、2（6.5%）和 3（9.7%）名参与者在基于培养的药敏试验中显示出 CLA、MET 和双重耐药。与基于培养的 MIC 试验相比，DPO 基多重 PCR 确定 CLA 耐药的准确性为 90.3%，而调查确定 MET 耐药的准确性仅为 77.4%。
基于 DPO-PCR 和既往抗生素使用史的靶向治疗在临床实践中是有用的，并且与基于培养的药敏试验相关性良好。
