Boyanova Lyudmila, Hadzhiyski Petyo, Markovska Rumyana, Gergova Raina
1 Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria.
2 Specialized Hospital for Active Pediatric Treatment, Medical University of Sofia, Sofia, Bulgaria.
Acta Microbiol Immunol Hung. 2022 Feb 2. doi: 10.1556/030.2022.01682.
Antibiotic resistance of Helicobacter pylori strains from 106 symptomatic children was evaluated according to EUCAST breakpoints and rate of multidrug resistance (MDR) was analyzed. Overall resistance rates were amoxicillin 7.5%, metronidazole 25.5%, clarithromycin 34.0% and ciprofloxacin 14.1%. There were no significant differences in resistance rates according to patients' age (2-6 and 7-18 years) and sex. Combined resistance rate was 19.8%, including double, triple, and quadruple resistance in 13.2% (14 strains), 5.7% (6) and 0.9% (1) of the strains, respectively. MDR was found in 5.9% (5/84) of the children with gastritis and in two of the four children with celiac disease. The MDR was present in three children aged 4-6 years and in four children aged 10-17 years. The total MDR rate (6.6%) in Bulgarian children in 2012-2021 was higher than those in other studies based on EUCAST breakpoints such as those in pediatric patients in Slovenia in 2011-2014 (3.8%), Lithuania in 2013-2015 (0%) and Spain in 2014-2019 (0%), although being lower than those (20.7% in the untreated and 47.0% in the treated children) in China in 2019. In brief, it is of concern that MDR can strongly limit the choice of H. pylori therapy of one out of fifteen Bulgarian children and that overall resistance to both metronidazole and clarithromycin can hinder the treatment of 15.1% of the pediatric patients. Susceptibility-guided tailored eradication therapy of H. pylori infection should be more frequently implemented in the symptomatic children to avoid risks of both the infection itself and multiple antibiotic treatments.
根据欧洲抗菌药物敏感性试验委员会（EUCAST）的断点标准，对106名有症状儿童的幽门螺杆菌菌株的抗生素耐药性进行了评估，并分析了多重耐药（MDR）率。总体耐药率分别为阿莫西林7.5%、甲硝唑25.5%、克拉霉素34.0%和环丙沙星14.1%。根据患者年龄（2至6岁和7至18岁）和性别，耐药率无显著差异。联合耐药率为19.8%，包括双重、三重和四重耐药，分别占菌株的13.2%（14株）、5.7%（6株）和0.9%（1株）。在患有胃炎的儿童中，5.9%（5/84）发现有MDR，在4名患有乳糜泻的儿童中有2名发现有MDR。MDR存在于3名4至6岁的儿童和4名10至17岁的儿童中。2012 - 2021年保加利亚儿童的总MDR率（6.6%）高于其他基于EUCAST断点标准的研究，如2011 - 2014年斯洛文尼亚儿科患者的研究（3.8%）、2013 - 2015年立陶宛的研究（0%）和2014 - 2019年西班牙的研究（0%），尽管低于2019年中国的研究（未治疗儿童中为20.7%，治疗儿童中为47.0%）。简而言之，令人担忧的是，MDR会严重限制十五分之一保加利亚儿童的幽门螺杆菌治疗选择，并且对甲硝唑和克拉霉素的总体耐药性会阻碍15.1%的儿科患者的治疗。对于有症状的儿童，应更频繁地实施敏感性指导的幽门螺杆菌感染个体化根除治疗，以避免感染本身和多次抗生素治疗的风险。
