Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.
Intern Med J. 2022 Sep;52(9):1554-1560. doi: 10.1111/imj.15640. Epub 2022 Aug 19.
Helicobacter pylori infection is responsible for considerable morbidity and mortality worldwide, and eradication rates are falling in many countries, primarily due to clarithromycin and metronidazole resistance.
There is a paucity of contemporary Australian data, which we sought to address by evaluating local rates of resistance of H. pylori to amoxicillin, clarithromycin, metronidazole and tetracycline over the past 20 years.
All gastric biopsy specimens collected at endoscopy to detect H. pylori infection at a single centre underwent routine culture and antibiotic susceptibility testing between 1998 and 2017. Specimens from 12 842 patients were cultured for H. pylori, of which 1473 positive cultures were tested for antibiotic susceptibility.
Antibiotic resistance to clarithromycin increased by 3.7% per year (incidence rate ratio [IRR] 1.037; P = 0.014) over 20 years, with a corresponding 5.0% annual increase in minimum inhibitory concentration (MIC) (odds ratio 1.050; P < 0.001). Since 2010, average clarithromycin resistance has exceeded 20%, with >25% of isolates resistant in the past 2 years of data capture. In contrast, rates of resistance to metronidazole (35.3%), amoxicillin (0.14%) and tetracycline (0.34%) and their MIC have remained stable. Review of a representative sample (n = 120; 8%) of these patients revealed that only 5% had documented prior H. pylori eradication therapy.
Over the past 20 years there has been a substantial rise in clarithromycin resistance, with stable metronidazole resistance and low rates of resistance to amoxicillin and tetracycline. Current first-line H. pylori eradication therapy may fail to achieve adequate eradication rates, and optimal first-line therapy in Australia should be revisited.
幽门螺杆菌感染在全球范围内导致了相当高的发病率和死亡率，许多国家的根除率正在下降，主要原因是克拉霉素和甲硝唑耐药。
我们缺乏当代澳大利亚的数据，因此我们试图通过评估过去 20 年来幽门螺杆菌对阿莫西林、克拉霉素、甲硝唑和四环素的耐药率来解决这个问题。
在一个中心，所有在胃镜检查中采集的用于检测幽门螺杆菌感染的胃活检标本在 1998 年至 2017 年间进行了常规培养和抗生素药敏试验。对 12842 例患者的标本进行了幽门螺杆菌培养，其中 1473 例阳性培养物进行了抗生素药敏试验。
过去 20 年中，克拉霉素的耐药率每年增加 3.7%（发病率比 [IRR] 1.037；P = 0.014），最小抑菌浓度（MIC）相应每年增加 5.0%（比值比 1.050；P < 0.001）。自 2010 年以来，平均克拉霉素耐药率超过 20%，在过去 2 年的数据采集期间，超过 25%的分离物耐药。相比之下，甲硝唑（35.3%）、阿莫西林（0.14%）和四环素（0.34%）的耐药率及其 MIC 保持稳定。对这些患者的代表性样本（n = 120；8%）的回顾显示，只有 5%的患者有记录的既往幽门螺杆菌根除治疗。
过去 20 年中，克拉霉素耐药率显著上升，甲硝唑耐药率稳定，阿莫西林和四环素耐药率较低。目前的一线幽门螺杆菌根除治疗可能无法达到足够的根除率，澳大利亚的最佳一线治疗方案应重新考虑。
