Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Int J Antimicrob Agents. 2024 Nov;64(5):107325. doi: 10.1016/j.ijantimicag.2024.107325. Epub 2024 Sep 6.
Empirical treatment needs to be supported by regional data, but knowledge of interregional differences is currently lacking in China. This study aimed to summarize and map the primary and secondary antibiotic resistance of Helicobacter pylori in different regions of mainland China.
PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure and Wanfang databases were systematically reviewed for studies published between 1 January 2000 and 15 July 2023. Data related to primary and secondary H. pylori antibiotic resistance rates were included. Random-effects models were used to synthesize the pooled resistance rates.
Ultimately, 74 studies were included in the final analysis. A total of 16 provinces reported resistance data. The overall resistance rates of H. pylori in mainland China were 30.72% (95% CI 27.53%-33.99%) to clarithromycin, 70.14% (95% CI 29.53%-37.46%) to metronidazole and 32.98% (95% CI 28.73%-37.37%) to levofloxacin; for amoxicillin, tetracycline, and furazolidone, the rates were 2.41% (95% CI 1.43%-3.60%), 2.53% (95% CI 1.19%-4.28%) and 1.54% (95% CI 0.28%-3.62%), respectively. Spatial and temporal differences were observed. The resistance rates increased after treatment failure; however, secondary resistance to amoxicillin, tetracycline and furazolidone were still low across the vast majority of study regions.
Surveillance of the updated prevalence of antibiotic resistance of H. pylori for different regions is warranted, which should factor into clinical decision making and guideline recommendations.
经验性治疗需要以区域性数据为支撑，但目前中国对地区间差异的认识还很缺乏。本研究旨在总结和绘制中国大陆不同地区幽门螺杆菌的主要和次要抗生素耐药性，并绘制耐药性图谱。
系统检索了 2000 年 1 月 1 日至 2023 年 7 月 15 日期间发表的 PubMed、EMBASE、Web of Science、中国知网和万方数据库中的研究，纳入了有关幽门螺杆菌主要和次要抗生素耐药率的数据。使用随机效应模型对汇总的耐药率进行了综合分析。
最终有 74 项研究纳入了最终分析。共有 16 个省份报告了耐药数据。中国大陆幽门螺杆菌的总体耐药率为：克拉霉素 30.72%（95%可信区间 27.53%-33.99%）、甲硝唑 70.14%（95%可信区间 29.53%-37.46%）和左氧氟沙星 32.98%（95%可信区间 28.73%-37.37%）；阿莫西林、四环素和呋喃唑酮的耐药率分别为 2.41%（95%可信区间 1.43%-3.60%）、2.53%（95%可信区间 1.19%-4.28%）和 1.54%（95%可信区间 0.28%-3.62%）。观察到了时空差异。治疗失败后耐药率增加，但在绝大多数研究地区，对阿莫西林、四环素和呋喃唑酮的继发性耐药仍然较低。
有必要对不同地区的幽门螺杆菌抗生素耐药性的最新流行情况进行监测，这应纳入临床决策和指南建议。
