Program de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile.
Hospital Dr. Sótero del Río, Santiago, Chile; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile.
Arch Med Res. 2021 Jul;52(5):529-534. doi: 10.1016/j.arcmed.2021.01.011. Epub 2021 Feb 12.
Treatments for Helicobacter pylori (H. pylori) eradication include the use of antibiotics and a proton-pump inhibitor. Antibiotic resistance is a major concern for two drugs: levofloxacin and clarithromycin. The aim was to determine the prevalence of levofloxacin resistance (LevoR) and clarithromycin resistance (ClaR) in an urban population in Santiago, Chile.
Gastric mucosa biopsies were obtained for DNA isolation from 143 H. pylori-positive individuals aged 18-80 years. Direct sequencing of the quinolone-resistance determining region (QRDR) of the gyrA gene was used to determine LevoR. ClaR was determined using restriction-fragment length polymorphism or 5'exonuclease assay.
The prevalences of LevoR and ClaR were 29 and 27%, respectively. LevoR was higher in women than in men (39 vs. 13%, p <0.001), while no sex difference was observed for ClaR (p = 0.123). The prevalence of LevoR increased with age (p-trend = 0.004) but not for ClaR (p-trend = 0.054). In sex-stratified analyses, both LevoR and ClaR increased with age only among women. Older women (>50 years) had a higher probability to carry LevoR strains as compared to men. The prevalence of dual LevoR and ClaR was 12.6%.
The prevalence of ClaR and LevoR is high in Santiago, according to International guidelines that recommend avoiding schemes with antibiotic resistance >15%. Our findings provide evidence to re-evaluate current therapies and guide empirical first- and second-line eradication treatments in Chile.
治疗幽门螺杆菌 (H. pylori) 根除包括使用抗生素和质子泵抑制剂。抗生素耐药性是两种药物的主要关注点：左氧氟沙星和克拉霉素。目的是确定智利圣地亚哥市区人群中左氧氟沙星耐药（LevoR）和克拉霉素耐药（ClaR）的流行率。
从 143 名年龄在 18-80 岁的 H. pylori 阳性个体中获得胃黏膜活检标本以分离 DNA。使用直接测序喹诺酮耐药决定区（QRDR）的gyrA 基因来确定 LevoR。使用限制性片段长度多态性或 5'外切核酸酶测定法来确定 ClaR。
LevoR 和 ClaR 的流行率分别为 29%和 27%。女性的 LevoR 高于男性（39%比 13%，p<0.001），而 ClaR 则无性别差异（p=0.123）。LevoR 的流行率随年龄增加而增加（p 趋势=0.004），但 ClaR 则不然（p 趋势=0.054）。在按性别分层的分析中，只有女性的 LevoR 和 ClaR 随年龄增加而增加。年龄较大的女性（>50 岁）携带 LevoR 菌株的可能性高于男性。双重 LevoR 和 ClaR 的流行率为 12.6%。
根据建议避免耐药率>15%的抗生素方案的国际指南，圣地亚哥的 ClaR 和 LevoR 流行率较高。我们的研究结果提供了证据，可重新评估当前的治疗方法并指导智利的经验性一线和二线根除治疗。
