Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
Helicobacter. 2022 Feb;27(1):e12868. doi: 10.1111/hel.12868. Epub 2021 Dec 27.
Variation in Helicobacter pylori (H. pylori) disease in terms of prevalence and antibiotic resistance prevails globally requiring a need to develop region-specific surveillance. We aimed to assess the influence of immigration factors upon the interpretation of local Singaporean epidemiological trends in antimicrobial susceptibility patterns and therapeutic outcomes in children with culture-positive H. pylori.
We retrospectively analyzed eradication outcomes of children with culture-proven H. pylori infections between 2011 and 2020 at our center, and we also analyzed the antimicrobial susceptibility profiles of the corresponding H. pylori isolates. The cohort was classified into two groups: (1) Native Singaporeans and (2) Non-native Singaporeans (First-/Second-generation immigrants and Non-residents) to correlate with resistance patterns and eradication outcomes. H. pylori culture was done via Kirby-Bauer disk diffusion for the era 2011-2016 and bioMérieux E test for 2016-2020.
A total of 70 children (median age 14 [2-17] years) were included in the analysis. 42.9% (30/70) of the cohort displayed some form of antibiotic resistance; clarithromycin resistance was the most prevalent (30.0%), followed by metronidazole (27.5%) and amoxicillin (7.1%). Comparing to natives, non-native Singaporeans were significantly younger at presentation (mean 11.7 vs. 13.7 years, p = 0.043), and a significantly higher proportion of non-natives carried clarithromycin-resistant (51.4% vs. 8.6%, p < 0.001), metronidazole-resistant (47.1% vs. 8.6%, p < 0.001), or multidrug-resistant (resistant to ≥2 drugs) (40.0% vs. 2.9%, p < 0.001] strains. Non-natives were significantly more likely to fail first-line eradication therapy (48.5% failure vs. 23.3%, p = 0.038). The proportion of pan-sensitive H. pylori was significantly lower in first-generation (25.0%, p = 0.001) and second-generation (42.9%, p = 0.018) immigrants compared to natives (82.86%). These conclusions did not vary when the analysis was repeated for each culture method.
An antibiotic susceptibility-based approach should be advocated for all patients but especially so for non-natives, who are at higher risk for antimicrobial resistant strains and poorer eradication outcomes.
全球范围内，幽门螺杆菌（H. pylori）疾病在流行率和抗生素耐药性方面存在差异，因此需要制定针对特定地区的监测方案。我们旨在评估移民因素对新加坡本地人群中儿童幽门螺杆菌感染的抗生素敏感性模式和治疗结果的影响。
我们回顾性分析了 2011 年至 2020 年间在我们中心进行的培养阳性 H. pylori 感染儿童的根除治疗结果，并分析了相应 H. pylori 分离株的抗生素敏感性谱。该队列分为两组：（1）新加坡本地人，（2）非新加坡本地人（第一代/第二代移民和非居民），以相关性与耐药模式和根除结果相关联。H. pylori 培养采用 Kirby-Bauer 纸片扩散法进行，时代为 2011-2016 年，生物梅里埃 E 试验为 2016-2020 年。
共纳入 70 例儿童（中位年龄 14 [2-17] 岁）进行分析。42.9%（30/70）的患儿存在某种形式的抗生素耐药性；克拉霉素耐药最为常见（30.0%），其次是甲硝唑（27.5%）和阿莫西林（7.1%）。与本地人相比，非新加坡本地人在就诊时明显更年轻（平均 11.7 岁比 13.7 岁，p=0.043），且非本地人携带克拉霉素耐药（51.4%比 8.6%，p<0.001）、甲硝唑耐药（47.1%比 8.6%，p<0.001）或多药耐药（耐药≥2 种药物）的比例明显更高（40.0%比 2.9%，p<0.001）。非本地人首次根除治疗失败的可能性明显更高（48.5%失败率比 23.3%，p=0.038）。第一代（25.0%，p=0.001）和第二代（42.9%，p=0.018）移民中全敏感 H. pylori 的比例明显低于本地人（82.86%）。当针对每种培养方法重复分析时，这些结论没有改变。
应提倡基于抗生素敏感性的方法对所有患者进行治疗，但对于非本地人尤其如此，因为他们更容易感染抗生素耐药菌株，治疗效果也更差。
