Department of Internal medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Dig Dis. 2021;39(5):451-461. doi: 10.1159/000514278. Epub 2021 Jan 11.
BACKGROUND/AIM: Antimicrobial resistance significantly affects the cure rate of Helicobacter pylori (H. pylori) eradication. We evaluated the risk factor of failure in ultimate H. pylori eradication and assessed the efficacy of current regimens to overcome antibiotic resistance.
Patients with H. pylori infection were prospectively enrolled in a single center. They were classified into 3 groups according to the previous history of H. pylori eradication, and antibiotic susceptibility was evaluated by culture and minimum inhibitory concentrations (MICs).
Ninety-seven patients were successfully cultured for H. pylori and 81 (83.5%), 7 (7.2%), and 9 (9.3%) were classified into primary resistance, 1st eradication failure, and 2nd or more eradication failure groups; the resistance to clarithromycin (CLA), metronidazole (MET), and levofloxacin increased in the 1st eradication failure (85.7, 57.1, and 42.9%) and 2nd or more eradication failure (88.9, 88.9, and 55.6%) groups. The prevalence of MDR was 21.0% (17/81), 57.1% (4/7), and 88.9% (8/9) in the primary, 1st eradication failure, and 2nd or more eradication failure groups, respectively. In multivariate analysis, dual CLA/MET resistance (CLA/MET-R) (OR = 31.432, 95% CI: 3.094-319.266, p = 0.004) was an independent risk factor for ultimate H. pylori eradication failure. In patients with dual CLA/MET-R, the eradication ratio of concomitant therapy was 57.1% (4/7), whereas that of bismuth-containing quadruple therapy was 27.3% (3/11) (p = 0.350).
Dual CLA/MET-R was the main cause of failure in ultimate H. pylori eradication, and 7-day bismuth quadruple or concomitant regimen would not be suitable for H. pylori eradication in the dual CLA/MET-R group.
背景/目的：抗生素耐药性显著影响幽门螺杆菌（H. pylori）根除的治愈率。我们评估了终极 H. pylori 根除失败的风险因素，并评估了克服抗生素耐药性的当前方案的疗效。
前瞻性纳入单中心 H. pylori 感染患者。根据 H. pylori 根除的既往史，将他们分为 3 组，并通过培养和最小抑菌浓度（MIC）评估抗生素敏感性。
97 例患者成功培养出 H. pylori，81 例（83.5%）、7 例（7.2%）和 9 例（9.3%）分别归入原发性耐药、首次根除失败和 2 次或更多次根除失败组；首次根除失败（85.7%、57.1%和 42.9%）和 2 次或更多次根除失败（88.9%、88.9%和 55.6%）组中克拉霉素（CLA）、甲硝唑（MET）和左氧氟沙星的耐药率增加。主要耐药（MDR）率在原发性、首次根除失败和 2 次或更多次根除失败组中分别为 21.0%（17/81）、57.1%（4/7）和 88.9%（8/9）。多变量分析显示，克拉霉素/甲硝唑双重耐药（CLA/MET-R）（OR=31.432，95%CI：3.094-319.266，p=0.004）是终极 H. pylori 根除失败的独立危险因素。在 CLA/MET-R 双重耐药患者中，联合治疗的根除率为 57.1%（4/7），而含铋四联疗法的根除率为 27.3%（3/11）（p=0.350）。
克拉霉素/甲硝唑双重耐药是终极 H. pylori 根除失败的主要原因，7 天铋四联或联合方案不适合克拉霉素/甲硝唑双重耐药组的 H. pylori 根除。
