幽门螺杆菌感染患者对克拉霉素和甲硝唑的异质性耐药：系统评价和荟萃分析。

Heteroresistance to clarithromycin and metronidazole in patients with a Helicobacter pylori infection: a systematic review and meta-analysis.

机构信息

Laboratory Sciences Research Centre, Golestan University of Medical Sciences, Gorgan, Iran.

Clinical Microbiology Research Centre, Ilam University of Medical Sciences, Ilam, Iran.

出版信息

Ann Clin Microbiol Antimicrob. 2022 May 20;21(1):19. doi: 10.1186/s12941-022-00509-3.

DOI:10.1186/s12941-022-00509-3

PMID:35596211

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9123761/

Abstract

BACKGROUND

Antimicrobial resistance of H. pylori can lead to treatment failure. Importantly, several studies have reported on heteroresistance, i.e. the presence of resistant and susceptible H. pylori populations in the same sample and/or a difference in the susceptibility patterns between biopsy samples. This meta-analysis aims to provide comprehensive data on the prevalence of metronidazole and clarithromycin heteroresistance and the approaches to their detection.

MATERIAL AND METHODS

A systematic review was performed after the search of MEDLINE, Scopus and Web of Science. The study outcomes were the weighted pooled prevalence of heteroresistance to clarithromycin and metronidazole in H. pylori positive samples and/or isolates with a subanalysis by continent.

RESULTS

A total of 22 studies that had investigated 3852 H. pylori positive patients were included in the meta-analysis. Heteroresistance to clarithromycin was reported in 20 studies, with a weighted pooled prevalence of 6.8% (95% CI 5.1-8.6; 3654 H. pylori positive patients; the substantial heterogeneity I = 55.6%). Heteroresistance to metronidazole was reported in 12 studies, with a weighted pooled prevalence of 13.8% (95% CI 8.9-18.6; 1670 H. pylori positive patients; the substantial heterogeneity I = 60.9%). The weighted pooled prevalence of clarithromycin heteroresistance was similar in Asia and Europe (p = 0.174584), however, metronidazole heteroresistance was detected more often in Europe (p < 0.00001). Clarithromycin heteroresistance was detected more often by phenotype rather than by using genotyping methods (12 vs 8 studies), whereas heteroresistance to metronidazole was detected only by phenotype.

CONCLUSION

The prevalence of heteroresistance to clarithromycin and/or metronidazole is not negligible and can be detected in approximately 7 and 14% of H. pylori positive samples, respectively. These findings highlight the need to raise the awareness of gastroenterologists and microbiologists to the heteroresistance to clarithromycin and metronidazole in patients with a H. pylori infection.

摘要

背景

幽门螺杆菌的抗生素耐药性可能导致治疗失败。重要的是，几项研究报告了异质性耐药，即在同一样本中存在耐药和敏感的幽门螺杆菌种群，和/或活检样本之间的药敏模式存在差异。本荟萃分析旨在提供关于甲硝唑和克拉霉素异质性耐药的流行率以及检测方法的综合数据。

材料和方法

在 MEDLINE、Scopus 和 Web of Science 进行系统检索后进行了这项研究。研究结果是幽门螺杆菌阳性样本和/或分离株中克拉霉素和甲硝唑异质性耐药的加权汇总流行率，并有大陆亚分析。

结果

共纳入了 22 项研究，这些研究共调查了 3852 例幽门螺杆菌阳性患者。20 项研究报告了克拉霉素异质性耐药，加权汇总流行率为 6.8%（95%CI 5.1-8.6；3654 例幽门螺杆菌阳性患者；高度异质性 I=55.6%）。12 项研究报告了甲硝唑异质性耐药，加权汇总流行率为 13.8%（95%CI 8.9-18.6；1670 例幽门螺杆菌阳性患者；高度异质性 I=60.9%）。亚洲和欧洲的克拉霉素异质性耐药加权汇总流行率相似（p=0.174584），但欧洲检测到的甲硝唑异质性耐药更多（p<0.00001）。克拉霉素异质性耐药更多地通过表型而非基因分型方法检测到（12 项 vs 8 项研究），而甲硝唑异质性耐药仅通过表型检测到。