2000年至2023年世界卫生组织各区域儿童幽门螺杆菌抗生素耐药性的全球流行情况：一项系统评价和荟萃分析。
Global prevalence of Helicobacter pylori antibiotic resistance among children in the world health organization regions between 2000 and 2023: a systematic review and meta-analysis.
作者信息
Salahi-Niri Aryan, Nabavi-Rad Ali, Monaghan Tanya Marie, Rokkas Theodore, Doulberis Michael, Sadeghi Amir, Zali Mohammad Reza, Yamaoka Yoshio, Tacconelli Evelina, Yadegar Abbas
机构信息
Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.
出版信息
BMC Med. 2024 Dec 23;22(1):598. doi: 10.1186/s12916-024-03816-y.
BACKGROUND
Helicobacter pylori infection causes gastritis, peptic ulcers, and gastric cancer. The infection is typically acquired in childhood and persists throughout life. The major impediment to successful therapy is antibiotic resistance. This systematic review and meta-analysis aimed to comprehensively assess the global prevalence of antibiotic resistance in pediatric H. pylori infection.
METHODS
We performed a systematic search of publication databases that assessed H. pylori resistance rates to clarithromycin, metronidazole, levofloxacin, amoxicillin, and tetracycline in children. The WHO region classification was used to group pooled primary and secondary resistance estimates along with 95% confidence interval (CI). H. pylori antibiotic resistance rates were retrieved and combined with odds ratios (95% CI) to investigate the global prevalence and temporal trends. Subgroup analysis of the prevalence of antibiotic resistance was conducted by country, age groups, and susceptibility testing methods.
RESULTS
Among 1417 records obtained initially, 152 studies were selected for eligibility assessment after applying exclusion criteria in multiple steps. Ultimately, 63 studies involving 15,953 individuals were included comprising data from 28 countries in 5 WHO regions. The primary resistance rates were metronidazole 35.3% (5482/15,529, 95% CI: 28.7-42.6), clarithromycin 32.6% (5071/15,555, 95% CI: 27.7-37.9), tetracycline 2.1% (148/7033, 95% CI: 1.3-3.6), levofloxacin 13.2% (1091/8271, 95% CI: 9.3-18.4), and amoxicillin 4.8% (495/10305, 95% CI: 2.5-8.8). Raising antibiotic resistance was detected in most WHO regions.
CONCLUSIONS
The escalating trend of H. pylori antibiotic resistance in children warrants urgent attention globally. National and regional surveillance networks are required for antibiotic stewardship in children infected with H. pylori.
背景
幽门螺杆菌感染可导致胃炎、消化性溃疡和胃癌。这种感染通常在儿童期获得，并持续终生。成功治疗的主要障碍是抗生素耐药性。本系统评价和荟萃分析旨在全面评估儿童幽门螺杆菌感染中抗生素耐药性的全球流行情况。
方法
我们对评估儿童幽门螺杆菌对克拉霉素、甲硝唑、左氧氟沙星、阿莫西林和四环素耐药率的出版物数据库进行了系统检索。使用世界卫生组织（WHO）区域分类对汇总的原发和继发耐药性估计值以及95%置信区间（CI）进行分组。检索幽门螺杆菌抗生素耐药率，并结合比值比（95%CI）来研究全球流行情况和时间趋势。通过国家、年龄组和药敏试验方法对抗生素耐药性的流行情况进行亚组分析。
结果
在最初获得的1417条记录中，经过多步应用排除标准后，选择了152项研究进行资格评估。最终，纳入了63项研究，涉及15953名个体，包括来自WHO 5个区域28个国家的数据。主要耐药率为：甲硝唑35.3%（5482/15529，95%CI：28.7-42.6），克拉霉素32.6%（5071/15555，95%CI：27.7-37.9），四环素2.1%（148/7033，95%CI：1.3-3.6），左氧氟沙星13.2%（1091/8271，95%CI：9.3-18.4），阿莫西林4.8%（495/10305，95%CI：2.5-8.8）。在大多数WHO区域均检测到抗生素耐药性上升。
结论
儿童幽门螺杆菌抗生素耐药性的上升趋势值得全球紧急关注。对于感染幽门螺杆菌的儿童，需要建立国家和区域监测网络以进行抗生素管理。
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