Choe Younghee, Kim Joon Sung, Choi Hyun Ho, Kim Dae Bum, Park Jae Myung, Oh Jung Hwan, Kim Tae Ho, Cheung Dae Young, Chung Woo Chul, Kim Byung-Wook, Kim Sung Soo
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
Front Microbiol. 2022 Mar 25;13:857569. doi: 10.3389/fmicb.2022.857569. eCollection 2022.
Bismuth quadruple therapy (BQT) is recommended as empirical first-line therapy because it is not affected by antibiotic resistance. We examined whether past exposure to metronidazole affected BQT outcomes.
The records of seven hospitals were searched for patients who received BQT for eradication between 2009 and 2020. The association between past metronidazole exposure and the eradication rate was evaluated.
This study was a multicenter retrospective study. Around 37,602 people tested for infection were identified, and 7,233 received BQT. About 2,802 (38.7%) underwent a 13C-urea breath test to confirm eradication. The BQT efficacy was 86.4% among patients without metronidazole exposure and 72.8% among patients with exposure ( < 0.001). The eradication rate of BQT 14 days in patients with past exposure was higher than that of BQT <14 days (85.5 vs. 66.0%, = 0.009). Multivariate analysis revealed that past metronidazole exposure [odds ratio (OR) 2.6, 95% CI 1.8-3.7; < 0.001] and BQT <14 days (OR 1.5, 95% CI 1.2-2.0; = 0.002) were independent risk factors for eradication failure.
Past metronidazole exposure significantly lowered the BQT eradication rate. BQT 14 days should be recommended for patients with suspected metronidazole exposure.
铋剂四联疗法（BQT）因不受抗生素耐药性影响而被推荐作为经验性一线治疗方案。我们研究了既往甲硝唑暴露是否会影响BQT的治疗效果。
检索七家医院2009年至2020年间接受BQT进行根除治疗的患者记录。评估既往甲硝唑暴露与根除率之间的关联。
本研究为多中心回顾性研究。共识别出约37602名接受感染检测的患者，其中7233人接受了BQT治疗。约2802人（38.7%）接受了13C尿素呼气试验以确认根除情况。未暴露于甲硝唑的患者中BQT疗效为86.4%，暴露于甲硝唑的患者中为72.8%（<0.001）。既往暴露患者中BQT治疗14天的根除率高于BQT治疗<14天的患者（85.5%对66.0%，=0.009）。多因素分析显示，既往甲硝唑暴露[比值比（OR）2.6，95%置信区间1.8 - 3.7；<0.001]和BQT治疗<14天（OR 1.5，95%置信区间1.2 - 2.0；=0.002）是根除失败的独立危险因素。
既往甲硝唑暴露显著降低了BQT的根除率。对于疑似有甲硝唑暴露的患者，应推荐进行14天的BQT治疗。
