西班牙北部原发性抗菌药物耐药率及幽门螺杆菌感染率。一项为期13年的回顾性研究。

Primary antimicrobial resistance rates and prevalence of Helicobacter pylori infection in the north of Spain. A 13-year retrospective study.

作者信息

Morilla Ana Morilla, Álvarez-Argüelles Marta E, Duque Jose María, Armesto Edisa, Villar Henar, Melón Santiago

机构信息

Department of Microbiology, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain.

出版信息

Gastroenterol Hepatol. 2019 Oct;42(8):476-485. doi: 10.1016/j.gastrohep.2019.05.002. Epub 2019 Jul 16.

DOI:10.1016/j.gastrohep.2019.05.002

PMID:31324461

Abstract

OBJECTIVE

Helicobacter pylori resistance to antimicrobial agents is on the rise and it is thus imperative to be aware of local resistance rates. The main objective of the present study was to describe the evolution of primary antimicrobial resistance in H. pylori, analysing its antibiotic susceptibility over a 13-year period in a region of northern Spain, as well as host-related factors.

PATIENTS AND METHODS

Between 2004 and 2016 a total of 3426 patients who met the H. pylori eradication criteria underwent gastroscopy. The gastric biopsies were processed and those testing positive for H. pylori were identified and tested for clarithromycin, metronidazole and levofloxacin susceptibility using E-test.

RESULTS

H. pylori was isolated in 1604 (47%) patients, ranging from 63% (133/212) in 2004 to 39% (137/347) in 2016. Primary resistances to clarithromycin, metronidazole and levofloxacin were on average 19% (278/1116), 40% (572/865) and 17% (137/669), respectively. Clarithromycin resistance was 24% (167/686) in females and 15% (11/753) in males (p=0.0002); metronidazole resistance was 29% (72/246) in patients over 70 years compared to 42% (499/1190) in younger patients (p=0.0396); levofloxacin resistance increased with age, being 13% (57/439) in patients ≤55 years, 19% (46/236) for those between 56 and 70, and 26% (34/130) in patients >70 years (p=0.0087).

DISCUSSION

A decline in the prevalence of H. pylori infection was observed over the years, along with relatively high rates of primary resistance to clarithromycin, metronidazole and levofloxacin. Variations in resistance rates were found with sex and age.

摘要

目的

幽门螺杆菌对抗菌药物的耐药性呈上升趋势，因此必须了解当地的耐药率。本研究的主要目的是描述幽门螺杆菌对一线抗菌药物耐药性的演变情况，分析西班牙北部某地区13年间幽门螺杆菌的抗生素敏感性以及与宿主相关的因素。

患者与方法

2004年至2016年间，共有3426例符合幽门螺杆菌根除标准的患者接受了胃镜检查。对胃活检样本进行处理，鉴定出幽门螺杆菌检测呈阳性的样本，并使用E-test法检测其对克拉霉素、甲硝唑和左氧氟沙星的敏感性。

结果

1604例（47%）患者分离出幽门螺杆菌，比例从2004年的63%（133/212）降至2016年的39%（137/347）。对克拉霉素、甲硝唑和左氧氟沙星的初始耐药率分别平均为19%（278/1116）、40%（572/865）和17%（137/669）。克拉霉素耐药率女性为24%（167/686），男性为15%（11/753）（p=0.0002）；70岁以上患者甲硝唑耐药率为29%（72/246），较年轻患者的42%（499/1190）低（p=0.0396）；左氧氟沙星耐药率随年龄增长而升高，≤55岁患者为13%（57/439），56至70岁患者为19%（46/236），>70岁患者为26%（34/130）（p=0.0087）。