Department of Gastroenterology, Peking University First Hospital, Beijing, China.
Helicobacter. 2021 Aug;26(4):e12804. doi: 10.1111/hel.12804. Epub 2021 Apr 16.
Antibiotic resistance is the main cause of Helicobacter pylori (H. pylori) treatment failure. This study aimed to explore the characteristics of antibiotic resistance of H. pylori isolates in Beijing in the last 8 years and to estimate the impact of previous eradication failure on resistance patterns.
This retrospective study included data from a single center in Beijing from 2013 to 2020. Antibiotic susceptibility of 365 clinical H. pylori isolates was tested for amoxicillin, clarithromycin, metronidazole, levofloxacin, moxifloxacin, and tetracycline. The characteristics of the included patients and their previous eradication history were collected. Primary and secondary resistance rates of H. pylori to the six antibiotics and the impact of previous eradication failure on antibiotic resistance patterns were analyzed.
The overall primary resistance rates of amoxicillin, clarithromycin, metronidazole, levofloxacin, moxifloxacin, and tetracycline were 0.7%, 55.2%, 68.0%, 49.7%, 64.5%, and 0%, with no significant increase during the observed period; while the secondary resistance rates were 3.2%, 96.7%, 90.7%, 93.1%, 80.0%, and 0%, respectively. The secondary resistance rate of clarithromycin (p < .001), metronidazole (p = .001), and levofloxacin (p < .001) significantly increased to 100% as the number of previous eradication therapies increased and exhibited a linear association. For strains naive to eradication, only 6.8% were susceptible to all the antibiotics, while 32.4% were single resistant, and 60.8% dual or multiple resistant. Clarithromycin+metronidazole+fluoroquinolone multiple resistance was the predominant pattern (0 course: 21.6%, 1 course: 37.5%, 2 courses: 56.1%, ≥3 courses: 71.1%; p < .001) for patients with treatment failure. The prevalence of dual or multiple-resistance patterns increased significantly as the number of previous therapies increased.
The prevalence of primary and secondary resistance rates of clarithromycin, metronidazole, moxifloxacin, and levofloxacin were high in Beijing. Multiple-resistance patterns were common after treatment failure. Resistance rates of amoxicillin and tetracycline remained low and stable.
抗生素耐药性是导致幽门螺杆菌（H. pylori）治疗失败的主要原因。本研究旨在探讨过去 8 年来北京地区 H. pylori 分离株的抗生素耐药特征，并评估既往根除失败对耐药模式的影响。
这是一项回顾性研究，纳入了 2013 年至 2020 年期间北京某单一中心的数据。对 365 例临床 H. pylori 分离株进行了阿莫西林、克拉霉素、甲硝唑、左氧氟沙星、莫西沙星和四环素的药敏试验。收集了纳入患者的特征及其既往根除史。分析了 H. pylori 对 6 种抗生素的原发性和继发性耐药率，以及既往根除失败对抗生素耐药模式的影响。
阿莫西林、克拉霉素、甲硝唑、左氧氟沙星、莫西沙星和四环素的总体原发性耐药率分别为 0.7%、55.2%、68.0%、49.7%、64.5%和 0%，在观察期间无显著增加；而继发性耐药率分别为 3.2%、96.7%、90.7%、93.1%、80.0%和 0%。克拉霉素（p < 0.001）、甲硝唑（p = 0.001）和左氧氟沙星（p < 0.001）的继发性耐药率均显著增加至 100%，且与既往根除治疗次数呈线性相关。对于未接受过根除治疗的菌株，仅有 6.8%对所有抗生素均敏感，32.4%为单耐药，60.8%为双重或多重耐药。克拉霉素+甲硝唑+氟喹诺酮类药物的多重耐药模式是治疗失败患者的主要模式（0 疗程：21.6%，1 疗程：37.5%，2 疗程：56.1%，≥3 疗程：71.1%；p < 0.001）。随着既往治疗次数的增加，双重或多重耐药模式的发生率显著增加。
北京地区克拉霉素、甲硝唑、莫西沙星和左氧氟沙星的原发性和继发性耐药率较高。治疗失败后常见多重耐药模式。阿莫西林和四环素的耐药率仍较低且稳定。
