Zhou Danli, Wang Wuyu, Gu Lan, Han Meiling, Hao Wujuan, Huang Junfeng, Lin Qiong, Wang Yan
Department of Pharmacy, Affiliated Children's Hospital of Jiangnan University, Jiangsu University, Wuxi, China.
Department of Burns and Plastic Surgery, Affiliated Children's Hospital of Jiangnan University, Jiangsu University, Wuxi, China.
Front Pharmacol. 2024 Jun 3;15:1392787. doi: 10.3389/fphar.2024.1392787. eCollection 2024.
() infections typically occur in early childhood. Although the prevalence of in children is lower than that in adults, the eradication rate of this infection in children is relatively low because of resistance. In this study, we analyzed personalized treatment strategies to achieve treatment goals based on resistance characteristics. This retrospective single-center study was conducted between January 2019 and December 2022 and enrolled 1,587 children who presented with upper gastrointestinal symptoms and underwent endoscopy. culturing and antimicrobial susceptibility testing were performed. Culture-positive results for were obtained in 535 children. The resistance rates to clarithromycin (CLA), metronidazole (MET), and levofloxacin (LEV) were 39.8%, 78.1%, and 20.2%, respectively. None of the isolates were resistant to tetracycline (TET), amoxicillin (AMO), or furazolidone (FZD). Double resistance rates to CLA + MET, CLA + LEV, and MET + LEV were 19.1%, 3.0%, and 5.8%, respectively. Notably, triple-resistant to CLA + MET + LEV was 9.7%. Based on susceptibility tests, individualized triple therapy [proton pump inhibitor (PPI) +AMO + CLA/MET] was selected for 380 children with sensitive to MET and/or CLA. In 155 children resistant to CLA and MET, bismuth-based quadruple therapy was recommended; for unable to receive bismuth, concomitant therapy was recommended for 14 children (<8 years of age); triple therapy with TET was recommended for 141 children (>8 years of age), with 43 children (>14 years of age) requiring FZD rather than TET. Resistance to in Chinese children was relatively poor. Personalized therapy regimens should be based on susceptibility tests and avoided factors associated with treatment failure.
（）感染通常发生在儿童早期。虽然儿童中该感染的患病率低于成人，但由于耐药性，儿童中这种感染的根除率相对较低。在本研究中，我们基于耐药特征分析了实现治疗目标的个性化治疗策略。这项回顾性单中心研究于2019年1月至2022年12月进行，纳入了1587名出现上消化道症状并接受内镜检查的儿童。进行了培养和抗菌药敏试验。535名儿童获得了培养阳性结果。对克拉霉素（CLA）、甲硝唑（MET）和左氧氟沙星（LEV）的耐药率分别为39.8%、78.1%和20.2%。分离株对四环素（TET）、阿莫西林（AMO）或呋喃唑酮（FZD）均无耐药。对CLA + MET、CLA + LEV和MET + LEV的双重耐药率分别为19.1%、3.0%和5.8%。值得注意的是，对CLA + MET + LEV的三重耐药率为9.7%。根据药敏试验，为380名对MET和/或CLA敏感的儿童选择了个体化三联疗法[质子泵抑制剂（PPI）+ AMO + CLA/MET]。在155名对CLA和MET耐药的儿童中，推荐铋剂四联疗法；对于无法接受铋剂的14名儿童（<8岁），推荐联合疗法；对于141名儿童（>8岁）推荐TET三联疗法，43名儿童（>14岁）需要FZD而非TET。中国儿童对该感染的耐药性相对较差。个性化治疗方案应基于药敏试验并避免与治疗失败相关的因素。
