Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.
J Gastroenterol Hepatol. 2021 Jun;36(6):1450-1456. doi: 10.1111/jgh.15352. Epub 2021 Jan 3.
While the global prevalence of antibiotic-resistant Helicobacter pylori (H. pylori) is increasing, there is much regional variation, and local data are required to guide eradication therapy. We performed a systematic review and meta-analysis to determine rates of H. pylori antibiotic resistance in Australia and New Zealand.
Random effects meta-analysis of data from 15 published studies and three published abstracts reporting prevalence of primary or secondary H. pylori antibiotic resistance in Australasia.
PubMed, EMBASE, MEDLINE, PROSPERO, and the Cochrane Library were searched until August, 2020.
Fifteen published studies and three published abstracts were identified; one study was excluded due to high risk of bias. Seventeen studies conducted between 1996 and 2013 were included in the final analysis, 12 reporting primary and five reporting secondary antibiotic resistance. Prevalence of primary resistance was clarithromycin 7.4% (95% confidence interval [CI], 5.3-9.7%), metronidazole 50.0% (95%CI, 23.9-56.1%), fluoroquinolones 3.7% (95%CI, 0.004-14.8%), and both amoxicillin and tetracycline <0.5%. Subgroup analysis (last 20 years) showed doubling of clarithromycin resistance to 16.1% (95%CI 11.2-21.7%) with other resistance stable. Prevalence of secondary resistance was high for all antibiotics, particularly clarithromycin 78.7% (95%CI, 64.1-90.1%) and metronidazole 68.3% (95%CI, 59.9-76.1%).
The outcomes reveal an increase in primary H. pylori clarithromycin resistance since the year 2000, while metronidazole resistance has remained stable and primary resistance to amoxicillin, tetracycline, and fluoroquinolones is low. Rates of secondary resistance to metronidazole and clarithromycin are high. The results highlight the need for contemporary local data on antibiotic resistance in Australia and New Zealand.
虽然全球范围内抗生素耐药幽门螺杆菌（H. pylori）的流行率正在上升，但存在很大的地区差异，需要当地数据来指导根除治疗。我们进行了系统评价和荟萃分析，以确定澳大利亚和新西兰的 H. pylori 抗生素耐药率。
对来自 15 项已发表研究和 3 项已发表摘要的数据进行随机效应荟萃分析，这些研究报告了澳大拉西亚原发性或继发性 H. pylori 抗生素耐药的流行率。
直到 2020 年 8 月，在 PubMed、EMBASE、MEDLINE、PROSPERO 和 Cochrane 图书馆进行了检索。
确定了 15 项已发表的研究和 3 项已发表的摘要，由于高偏倚风险，有 1 项研究被排除在外。最终分析纳入了 17 项 1996 年至 2013 年期间进行的研究，其中 12 项报告原发性耐药，5 项报告继发性耐药。原发性耐药的流行率为克拉霉素 7.4%（95%置信区间[CI]，5.3-9.7%），甲硝唑 50.0%（95%CI，23.9-56.1%），氟喹诺酮类 3.7%（95%CI，0.004-14.8%），阿莫西林和四环素均<0.5%。亚组分析（过去 20 年）显示克拉霉素耐药率增加到 16.1%（95%CI 11.2-21.7%），而其他耐药率稳定。所有抗生素的继发性耐药率都很高，尤其是克拉霉素 78.7%（95%CI，64.1-90.1%）和甲硝唑 68.3%（95%CI，59.9-76.1%）。
结果表明，自 2000 年以来，H. pylori 克拉霉素原发性耐药率有所增加，而甲硝唑耐药率保持稳定，阿莫西林、四环素和氟喹诺酮类的原发性耐药率较低。甲硝唑和克拉霉素的继发性耐药率很高。结果强调了澳大利亚和新西兰需要有当代当地抗生素耐药数据。
