台湾南部儿童幽门螺杆菌感染中克拉霉素和甲硝唑耐药性的增加：二十年的对比。

Increasing antimicrobial resistance to clarithromycin and metronidazole in pediatric Helicobacter pylori infection in southern Taiwan: A comparison between two decades.

机构信息

Departments of Pediatrics, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan.

Institutes of Clinical Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan.

出版信息

Helicobacter. 2019 Oct;24(5):e12633. doi: 10.1111/hel.12633. Epub 2019 Jul 11.

DOI:10.1111/hel.12633

PMID:31295754

Abstract

BACKGROUND

Antimicrobial resistance of Helicobacter pylori reduces the eradication rate. This study aimed to investigate changes in antimicrobial susceptibility of H pylori isolated from children in Taiwan in the past two decades.

METHODS

This study enrolled children receiving esophagogastroduodenoscopy for upper gastrointestinal diseases in a national tertiary referring hospital from 1998 to 2018. H pylori infection was diagnosed by culture. The minimal inhibitory concentrations (MICs) of antibiotics were tested using the E test. The antibiotic resistance rates and MICs of amoxicillin, clarithromycin, metronidazole, levofloxacin, and tetracycline were compared between 1998-2008 and 2009-2018.

RESULTS

A total of 70 Helicobacter pylori isolates (29 from 1998 to 2008 and 41 from 2009 to 2018) were identified. The esophagogastroduodenoscopy findings included duodenal ulcers (n = 31), gastric ulcers (n = 9), and gastritis (n = 30). The overall antimicrobial resistance rates of clarithromycin and metronidazole were 22.9% and 21.4%, respectively. The dual resistance rate of clarithromycin and metronidazole was 10%. Resistance rates of levofloxacin and amoxicillin were 8.3% and 2.9%, respectively. None of the isolates were resistant to tetracycline. Compared with the isolates from 1998 to 2008, those from 2009 to 2018 had higher MICs and resistance rates of clarithromycin (26.8% vs 17.2%, P = 0.35) and metronidazole (26.8% vs 13.8%, P = 0.19), but not levofloxacin (9.8% vs 5.3%, P = 1.0) or coresistance to clarithromycin and metronidazole (12.2% vs 6.9%, P = 0.69).

CONCLUSIONS

The antimicrobial resistance rates of pediatric H pylori isolates to clarithromycin and metronidazole increased during the past decade. The selection of antimicrobial agents other than clarithromycin and metronidazole is crucial to increase pediatric H pylori eradication rates.

摘要

背景

幽门螺杆菌的耐药性降低了根除率。本研究旨在探讨过去二十年中台湾儿童分离的幽门螺杆菌的抗菌药物敏感性变化。

方法

本研究纳入了 1998 年至 2018 年在一家国家三级转诊医院因上消化道疾病接受胃镜检查的儿童。通过培养诊断幽门螺杆菌感染。采用 E 试验检测抗生素的最小抑菌浓度（MIC）。比较了 1998-2008 年和 2009-2018 年期间阿莫西林、克拉霉素、甲硝唑、左氧氟沙星和四环素的抗生素耐药率和 MIC。

结果

共鉴定出 70 株幽门螺杆菌（1998-2008 年 29 株，2009-2018 年 41 株）。胃镜检查结果包括十二指肠溃疡（n=31）、胃溃疡（n=9）和胃炎（n=30）。克拉霉素和甲硝唑的总抗菌药物耐药率分别为 22.9%和 21.4%。克拉霉素和甲硝唑的双重耐药率为 10%。左氧氟沙星和阿莫西林的耐药率分别为 8.3%和 2.9%。无分离株对四环素耐药。与 1998-2008 年分离株相比，2009-2018 年分离株的克拉霉素（26.8%比 17.2%，P=0.35）和甲硝唑（26.8%比 13.8%，P=0.19）MIC 和耐药率更高，但左氧氟沙星（9.8%比 5.3%，P=1.0）或克拉霉素和甲硝唑的共同耐药率（12.2%比 6.9%，P=0.69）没有差异。