Department of Gastroenterology, Thong Nhat General Hospital, Bien Hoa City, Dong Nai Province, Vietnam.
Department of Medical Genetics, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; Institute of Biomedicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
J Glob Antimicrob Resist. 2020 Sep;22:620-624. doi: 10.1016/j.jgar.2020.06.007. Epub 2020 Jun 24.
The increasing rates of clarithromycin (CLR)- and levofloxacin (LVX)-resistant Helicobacter pylori are the main causes of the considerable decrease in the eradication rates of triple therapy and LVX-based regimens. The aims of this study were to determine the rates of CLR- and LVX-resistant H. pylori by the Epsilometer test and to assess the risk factors for this antibiotic resistance among patients with chronic gastritis in the south east area of Vietnam.
Gastric biopsy specimens were obtained from 153 patients with H. pylori-positive chronic gastritis for use in culture and in the Epsilometer test to determine CLR and LVX susceptibilities.
The rates of H. pylori resistance to CLR and LVX were 72.6% and 40.5%, respectively. Dual-resistant H. pylori (to both CLR and LVX) accounted for 30.7% of patients. The rates of high-level resistance to CLR and LVX were 18.9% and 83.9%, respectively. Multivariate analysis showed that age older than 30 years (odds ratio [OR] = 3.80, 95% confidence interval [CI] 1.61-8.97) and history of H. pylori treatment (OR = 8.72, 95% CI 1.90-39.91) were independent risk factors for CLR resistance, whereas only age older than 35 years (OR = 2.42, 95% CI 1.23-4.76) was an independent risk factor for LVX resistance.
These results revealed high rates of resistance of H. pylori to CLR and LVX in patients with chronic gastritis in the south east area of Vietnam. This suggests that CLR-based triple therapy should not be used for the eradication treatment of H. pylori, and LVX susceptibility testing of H. pylori strains should be performed before choosing alternative regimens.
克拉霉素（CLR）和左氧氟沙星（LVX）耐药幽门螺杆菌的发生率不断增加，是导致三联疗法和基于 LVX 方案根除率显著下降的主要原因。本研究旨在通过 Etest 试验确定越南东南部地区慢性胃炎患者中 CLR 和 LVX 耐药幽门螺杆菌的发生率，并评估这种抗生素耐药的危险因素。
对 153 例 H. pylori 阳性慢性胃炎患者的胃活检标本进行培养和 Etest 试验，以确定 CLR 和 LVX 药敏性。
幽门螺杆菌对 CLR 和 LVX 的耐药率分别为 72.6%和 40.5%，双重耐药幽门螺杆菌（对 CLR 和 LVX 均耐药）占 30.7%。高水平 CLR 和 LVX 耐药率分别为 18.9%和 83.9%。多变量分析显示，年龄大于 30 岁（比值比[OR] = 3.80，95%置信区间[CI] 1.61-8.97）和有幽门螺杆菌治疗史（OR = 8.72，95% CI 1.90-39.91）是 CLR 耐药的独立危险因素，而仅年龄大于 35 岁（OR = 2.42，95% CI 1.23-4.76）是 LVX 耐药的独立危险因素。
这些结果表明，越南东南部地区慢性胃炎患者的幽门螺杆菌对 CLR 和 LVX 的耐药率较高。这表明基于 CLR 的三联疗法不应用于幽门螺杆菌的根除治疗，在选择替代方案之前，应进行幽门螺杆菌菌株的 LVX 药敏试验。
