儿童幽门螺杆菌感染的抗生素耐药性、异质性耐药性和根除成功率。

Antibiotic resistance, heteroresistance, and eradication success of Helicobacter pylori infection in children.

机构信息

Pediatric Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.

Microbiology Department, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Université Libre de Bruxelles, Brussels, Belgium.

出版信息

Helicobacter. 2023 Oct;28(5):e13006. doi: 10.1111/hel.13006. Epub 2023 Jul 4.

DOI:10.1111/hel.13006

PMID:37402147

Abstract

BACKGROUND

Antibiotic resistance is a well-known factor of Helicobacter pylori eradication failure. Heteroresistance indicates the coexistence of resistant and susceptible strains and might lead to underestimating antimicrobial resistance. This study aims to evaluate the susceptibility profile, the frequency of heteroresistance of H. pylori strains, and their effect on eradication success in a pediatric population.

MATERIALS AND METHODS

Children aged 2-17 years who underwent an upper gastrointestinal endoscopy from 2011 to 2019 with positive H. pylori status were included. Susceptibility was measured by disk diffusion and E-test. The difference in susceptibility profiles between isolates from the antrum and the corpus was used to detect heteroresistance. For those who received eradication treatment, we evaluated eradication rate and factors affecting treatment success.

RESULTS

Inclusion criteria were met by 565 children. Strains susceptible to all antibiotics were detected in 64.2%. Primary resistance rates for clarithromycin (CLA), metronidazole (MET), levofloxacin (LEV), tetracyclin (TET), and amoxicillin (AMO) were 11%, 22.9%, 6.9%, 0.4%, and 0% and secondary resistance rates were 20.4%, 29.4%, 9.3%, 0%, and 0%. Heteroresistance was present in untreated children in 2%, 7.1%, 0.7%, 0.7%, and 0% for CLA, MET, LEV, TET, and AMO. First-line eradication rates were 78.5% in intention-to-treat (ITT), 88.3% in full-analysis-set (FAS), and 94.1% in per-protocol (PP). Factors affecting eradication success were the duration of treatment when the triple-tailored treatment was used, the number of daily doses of amoxicillin administered, and the patient's adherence to treatment.

CONCLUSIONS

This study shows the presence of relatively low primary resistance rates for H. pylori isolates but demonstrates the presence of heteroresistance in our population. Routine biopsies from the antrum and corpus must be considered for susceptibility testing to allow tailored treatments and increase eradication rates. Treatment success is affected by treatment choice, correct dosing of medications, and adherence. All these factors should be considered when evaluating the efficacy of an eradication regimen.

摘要

背景

抗生素耐药性是幽门螺杆菌根除失败的已知因素。异质性耐药表明存在耐药和敏感菌株共存的情况，可能导致对抗菌药物耐药性的低估。本研究旨在评估儿童人群中幽门螺杆菌菌株的药敏谱、异质性耐药的频率及其对根除成功率的影响。

材料与方法

纳入 2011 年至 2019 年间因上消化道内镜检查结果阳性而接受治疗的 2-17 岁儿童。通过纸片扩散法和 E 试验测定药敏性。比较胃窦和胃体分离株的药敏谱差异，以检测异质性耐药。对于接受根除治疗的患者，评估根除率和影响治疗成功的因素。

结果

565 名儿童符合纳入标准。所有抗生素均敏感的菌株占 64.2%。克拉霉素（CLA）、甲硝唑（MET）、左氧氟沙星（LEV）、四环素（TET）和阿莫西林（AMO）的原发性耐药率分别为 11%、22.9%、6.9%、0.4%和 0%，继发性耐药率分别为 20.4%、29.4%、9.3%、0%和 0%。未经治疗的儿童中，CLA、MET、LEV、TET 和 AMO 的异质性耐药率分别为 2%、7.1%、0.7%、0.7%和 0%。意向治疗（ITT）、全分析集（FAS）和符合方案集（PP）的一线根除率分别为 78.5%、88.3%和 94.1%。影响根除成功率的因素包括使用三tailored 治疗时的治疗持续时间、阿莫西林每日剂量和患者对治疗的依从性。