Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, Ningbo, China.
Health Science Center, Ningbo University, Ningbo, China.
J Clin Lab Anal. 2023 Apr;37(7):e24885. doi: 10.1002/jcla.24885. Epub 2023 Apr 23.
Increasing rates of Helicobacter pylori resistance are associated with multiple clinical challenges. Bacterial factors linked to H. pylori resistance are mutations, efflux pumps, and biofilms. Gene mutations such as nucleic acid synthesis-related gene mutations, rRNA coding gene mutations, and cell wall synthesis-related gene mutations are the most important mechanisms by which H. pylori evades bactericidal effects. These mechanisms are also closely related to the biological activity of the efflux pump systems and biofilms. Activation of the efflux pump system and biofilm formation both lead to the emergence of MDR strains, further increasing the difficulty of eradication therapy. In this review, the status of antibiotic resistance in H. pylori from different regions and countries is summarized and compared, and H. pylori resistance profiles and their changing trends in the clinic are described. Then, research progress on biomolecular mechanisms underlying antibiotic resistance, diagnostic methods, and treatment strategies are introduced and discussed. Challenges resulting from increasing resistance, potential solutions to combat increasing resistance, and future directions are discussed to help clinicians and researchers better address the emergence and spread of resistant H. pylori strains and optimize drug regimens. With the rate of H. pylori resistance to commonly used antibiotics increasing, more attention should be given to the selection of antibiotics and to monitoring resistance when antibiotics are used for clinical eradication treatment. Individualized precise eradication treatment under the guidance of drug susceptibility testing will become the mainstream method of treatment in the future.
幽门螺杆菌耐药率的上升与多种临床挑战相关。与幽门螺杆菌耐药相关的细菌因素包括突变、外排泵和生物膜。与幽门螺杆菌逃避杀菌作用相关的最重要机制是核酸合成相关基因突变、rRNA 编码基因突变和细胞壁合成相关基因突变等基因突变。这些机制也与外排泵系统和生物膜的生物学活性密切相关。外排泵系统的激活和生物膜的形成都导致了多药耐药菌株的出现，进一步增加了根除治疗的难度。本综述总结和比较了不同地区和国家的幽门螺杆菌的抗生素耐药现状，描述了临床中幽门螺杆菌耐药谱及其变化趋势。然后，介绍和讨论了抗生素耐药的生物分子机制、诊断方法和治疗策略的研究进展。讨论了耐药性不断增加带来的挑战、潜在的解决方案以及未来的发展方向，以帮助临床医生和研究人员更好地应对耐药幽门螺杆菌菌株的出现和传播，并优化药物治疗方案。随着常用抗生素对幽门螺杆菌的耐药率不断上升，在进行临床根除治疗时应更加关注抗生素的选择，并监测耐药性。在药敏试验指导下进行个体化精准根除治疗将成为未来的主流治疗方法。
