Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China.
Zhiyuan Inspection Medical Institute, Hangzhou, China.
Helicobacter. 2024 Jan-Feb;29(1):e13038. doi: 10.1111/hel.13038. Epub 2023 Nov 20.
To investigate the antibiotic resistance of Helicobacter pylori (H. pylori) strains to clarithromycin, metronidazole, amoxicillin, levofloxacin, furazolidone, and tetracycline in Chinese children.
This multicenter, retrospective study was conducted from January 2016 through May 2023. Gastric mucosa biopsies were obtained from pediatric participants who underwent upper gastrointestinal endoscopy at 96 hospitals in northern, southwestern, and southeastern China. The susceptibility of H. pylori to six commonly used antibiotics was determined by agar dilution method.
Among the 3074 H. pylori isolates, 36.7% were resistant to clarithromycin, 77.3% to metronidazole, 16.6% to levofloxacin, and 0.3% to amoxicillin. No strains were detected to be resistant to furazolidone or tetracycline. During the 8-year study period, resistance to clarithromycin and metronidazole showed a significant upward trend, while the resistance pattern of the other antibiotics demonstrated a slight but nonsignificant fluctuation. Significant regional differences were found in the distribution of clarithromycin resistance among the northern (66.0%), southwestern (48.2%), and southeastern (34.6%) regions. The metronidazole resistance rate was significantly lower in the southeastern coastal region (76.3%) than in the other two regions (88.2% in the north and 87.7% in the southwest). Multi-drug resistance for two or more antibiotics was detected in 36.3% of the H. pylori strains, and the predominant multi-resistance pattern was the dual resistance to clarithromycin and metronidazole.
The prevalence of H. pylori resistance to clarithromycin and metronidazole is rather high in Chinese children and has been increasing over time. A relatively high resistance rate to levofloxacin was also noticed in children, while almost all strains were susceptible to amoxicillin, furazolidone, and tetracycline. It will be of great clinical significance to continuously monitor the antibiotic-resistance patterns of H. pylori in the pediatric population.
为了研究中国儿童幽门螺杆菌（H. pylori）对克拉霉素、甲硝唑、阿莫西林、左氧氟沙星、呋喃唑酮和四环素的耐药性。
这是一项多中心、回顾性研究，于 2016 年 1 月至 2023 年 5 月进行。从中国北部、西南部和东南部 96 家医院接受上消化道内镜检查的儿科参与者中获取胃黏膜活检。采用琼脂稀释法测定 H. pylori 对 6 种常用抗生素的敏感性。
在 3074 株 H. pylori 分离株中，36.7%对克拉霉素耐药，77.3%对甲硝唑耐药，16.6%对左氧氟沙星耐药，0.3%对阿莫西林耐药。未检测到对呋喃唑酮或四环素耐药的菌株。在 8 年的研究期间，克拉霉素和甲硝唑的耐药率呈显著上升趋势，而其他抗生素的耐药模式则略有波动但无统计学意义。北部（66.0%）、西南部（48.2%）和东南部（34.6%）地区克拉霉素耐药分布存在显著的区域差异。东南沿海地区甲硝唑耐药率明显低于其他两个地区（北部 88.2%，西南部 87.7%）。36.3%的 H. pylori 株存在两种或两种以上抗生素的多药耐药，主要的多耐药模式是克拉霉素和甲硝唑的双重耐药。
中国儿童 H. pylori 对克拉霉素和甲硝唑的耐药率相当高，且呈时间依赖性上升。儿童对左氧氟沙星的耐药率也较高，而几乎所有菌株对阿莫西林、呋喃唑酮和四环素均敏感。持续监测儿童人群中 H. pylori 的抗生素耐药模式具有重要的临床意义。
