Department of Gastroenterology and Hepatology, CHU Saint Pierre Université Libre de Bruxelles, Bruxelles, Belgium.
Department of Hospital Hygiene & Infection Control, CHU Saint Pierre Université Libre de Bruxelles, Bruxelles, Belgium.
Microbiologyopen. 2021 Jun;10(3):e1184. doi: 10.1002/mbo3.1184.
The antimicrobial susceptibility of Helicobacter pylori strains isolated from HIV-positive individuals is not well characterized. This study aimed to measure the prevalence and long-term trends associated with primary H. pylori antibiotic resistance, evaluate correlations with antibiotic consumption, and compare predictors for H. pylori antibiotic resistance between HIV-positive and HIV-negative individuals. In this longitudinal registry study, we evaluated consecutive adults with and without HIV infection, naïve to H. pylori treatment, who underwent upper gastrointestinal endoscopy and had a positive H. pylori culture, with susceptibility testing available, between 2004 and 2015. Outpatient antibiotic consumption data were based on nationwide aggregated numbers. H. pylori was isolated from gastric biopsies of 3008/8321 patients, 181/477 (37.9%) were HIV-positive and 2827/7844 (36.0%) HIV-negative. Overall cohort mean prevalence of H. pylori primary antibiotic resistance was 11.1% for clarithromycin, 17.8% levofloxacin, and 39.4% metronidazole. The prevalence of H. pylori primary resistance was significantly higher for these three drugs in HIV-positive individuals across the study period. Linear regression showed that the prevalence of clarithromycin and levofloxacin resistance correlated with the country aggregate daily dose consumption of macrolides and quinolones, respectively. Multivariable regression analysis showed that HIV infection is a strong independent risk factor for multiple H. pylori antibiotic resistance. In summary, HIV infection is a risk factor for carrying multi-resistant H. pylori strains and this is correlated with antibiotic consumption. Empirical therapies should be avoided in HIV-positive individuals. These data highlight the need to implement ongoing monitoring of H. pylori antimicrobial susceptibility among HIV-positive individuals. The study is registered at ISRCTN registry, number 13466428: https://www.isrctn.com/ISRCTN13466428.
从 HIV 阳性个体中分离的幽门螺杆菌菌株的抗菌药物敏感性尚不清楚。本研究旨在测量与原发性幽门螺杆菌抗生素耐药性相关的流行率和长期趋势，评估与抗生素消耗的相关性，并比较 HIV 阳性和 HIV 阴性个体中幽门螺杆菌抗生素耐药性的预测因素。在这项纵向登记研究中，我们评估了 2004 年至 2015 年间连续接受上消化道内窥镜检查且幽门螺杆菌培养阳性、有药敏试验结果、且未接受过幽门螺杆菌治疗的 HIV 感染和非 HIV 感染的成年人。门诊抗生素消耗数据基于全国汇总数据。从 3008/8321 例患者的胃活检中分离出幽门螺杆菌，其中 181/477（37.9%）为 HIV 阳性，2827/7844（36.0%）为 HIV 阴性。总体队列中幽门螺杆菌原发性抗生素耐药的总体流行率分别为克拉霉素 11.1%、左氧氟沙星 17.8%和甲硝唑 39.4%。在整个研究期间，HIV 阳性个体中这三种药物的幽门螺杆菌原发性耐药率显著更高。线性回归显示，克拉霉素和左氧氟沙星耐药的流行率分别与大环内酯类和喹诺酮类药物的国家总日剂量消耗相关。多变量回归分析显示，HIV 感染是多种幽门螺杆菌抗生素耐药的独立危险因素。总之，HIV 感染是携带多耐药幽门螺杆菌菌株的危险因素，这与抗生素消耗有关。应避免在 HIV 阳性个体中使用经验性治疗。这些数据强调需要对 HIV 阳性个体中的幽门螺杆菌抗菌药物敏感性进行持续监测。该研究在 ISRCTN 注册中心注册，编号为 13466428：https://www.isrctn.com/ISRCTN13466428。
