Liang Chih-Ming, Tai Wei-Chen, Hsu Pin-I, Wu Deng-Chyang, Kuo Chao-Hung, Tsay Feng-Woey, Lee Chia-Long, Chen Kuan-Yang, Chuah Seng-Kee
Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung.
Department of Medicine, An Nan Hospital, China Medical University.
Therap Adv Gastroenterol. 2020 Dec 10;13:1756284820976990. doi: 10.1177/1756284820976990. eCollection 2020.
Antibiotic resistance plays a crucial role in the treatment failure of infection. This study aimed to determine the trend of changes in the primary, secondary and tertiary antibiotic resistance of in Taiwan over the last 7 years.
We retrospectively analysed -infected isolates from patients with primary resistance ( = 1369), secondary resistance ( = 196) and tertiary resistance ( = 184) from January 2013 to December 2019. The strains were tested for susceptibility to amoxicillin, clarithromycin, levofloxacin, metronidazole and tetracycline using the Epsilometer test method.
A progressively higher primary resistance rate was observed for clarithromycin (11.8-20.4%, = 0.039 in χ test for linear trend), levofloxacin (17.3-38.8%, < 0.001) and metronidazole (25.6-42.3%, < 0.001) among naïve patients who received first-line eradication therapy. The dual primary resistance to clarithromycin and metronidazole also progressively increased in a linear trend (2.4-10.4%, = 0.009). For secondary resistance, an increase was observed for levofloxacin (30.5-64.7%, = 0.006) and metronidazole (40.5-77.4%, < 0.001). For tertiary resistance, the observed increase was even more significant for levofloxacin (65.9-100.0%, = 0.106) and metronidazole (44.4-88.2%, < 0.001). The resistance to amoxicillin and tetracycline remained very low in Taiwan regardless of primary, secondary and tertiary resistance.
Primary, secondary and tertiary antibiotic resistance to clarithromycin, levofloxacin and metronidazole for has been increasing in Taiwan since 2013. Treatment should be targeted for eradication success rates of more than 90%. Third-line treatment should be based on antibiotic susceptibility.
抗生素耐药性在感染治疗失败中起着关键作用。本研究旨在确定台湾地区过去7年中幽门螺杆菌对一线、二线和三线抗生素耐药性的变化趋势。
我们回顾性分析了2013年1月至2019年12月期间原发性耐药（n = 1369）、继发性耐药（n = 196）和三级耐药（n = 184）患者的幽门螺杆菌感染分离株。使用Epsilometer试验方法检测幽门螺杆菌菌株对阿莫西林、克拉霉素、左氧氟沙星、甲硝唑和四环素的敏感性。
在接受一线根除治疗的初治患者中，观察到克拉霉素（11.8 - 20.4%，线性趋势χ检验P = 0.039）、左氧氟沙星（17.3 - 38.8%，P < 0.001）和甲硝唑（25.6 - 42.3%，P < 0.001）的原发性耐药率逐渐升高。克拉霉素和甲硝唑的双重原发性耐药也呈线性趋势逐渐增加（2.4 - 10.4%，P = 0.009）。对于继发性耐药，观察到左氧氟沙星（30.5 - 64.7%，P = 0.006）和甲硝唑（40.5 - 77.4%，P < 0.001）有所增加。对于三级耐药，左氧氟沙星（65.9 - 100.0%，P = 0.106）和甲硝唑（44.4 - 88.2%，P < 0.001）的增加更为显著。无论原发性、继发性和三级耐药，台湾地区对阿莫西林和四环素的耐药性仍然很低。
自2013年以来，台湾地区幽门螺杆菌对克拉霉素、左氧氟沙星和甲硝唑的一线、二线和三线抗生素耐药性一直在增加。治疗应针对根除成功率超过90%。三线治疗应基于抗生素敏感性。
