桂西地区幽门螺杆菌对多种抗生素的耐药现状

目的了解广西桂西地区幽门螺杆菌（HP）对阿莫西林等四种抗生素的耐药现状。方法采集右江民族医学院附属医院近2年确诊为胃炎、胃溃疡患者的胃黏膜进行HP分离培养和鉴定,经鉴定后选择216株HP菌株,采用纸片扩散（K-B）法测定其对阿莫西林、甲硝唑、克拉霉素、左氧氟沙星四种抗生素的敏感性。结果 HP对阿莫西林、甲硝唑、克拉霉素、左氧氟沙星的耐药率2010年分别是22.8%、92.1%、30.5%、2%;2011年分别是24.3%、92.2%、31.3%、4.3%。结论胃炎及胃溃疡患者HP对阿莫西林、甲硝唑、克拉霉素、左氧氟沙星的耐药率有上升趋势,但上升幅度不大,对左氧氟沙星较敏感,可以考虑用左氧氟沙星替代甲硝唑和克拉霉素,以提高HP的根治率。     

幽门螺杆菌根除失败患者耐药情况分析

目的分析幽门螺杆菌(HP)感染治疗失败患者的耐药情况,为HP感染补救治疗提供指导。方法经¹³C呼气试验确诊HP治疗失败的门诊患者269例,行胃镜取胃窦小弯和胃体大弯黏膜标本进行培养。对HP培养阳性患者采用最低抑菌浓度试验药敏法分别行阿莫西林、克拉霉素、左氧氟沙星、甲硝唑、呋喃唑酮和四环素药敏试验。结果 269例患者中,190例HP培养阳性,HP阳性率为70.63%。HP培养阳性患者中,甲硝唑耐药菌株率为97.37%,克拉霉素耐药菌株率为58.95%,左氧氟沙星耐药菌株率为48.42%,无阿莫西林、呋喃唑酮和四环素耐药菌株。二重耐药的总耐药菌株率为44.74%;其中,甲硝唑和克拉霉素耐药菌株率为47.06%,甲硝唑和左氧氟沙星耐药菌株率为47.06%,克拉霉素和左氧氟沙星耐药菌株率为5.88%。对甲硝唑、克拉霉素和左氧氟沙星三重耐药菌株率为32.11%。结论抗生素耐药是HP治疗失败的重要原因,了解耐药情况有助于选择补救治疗的个体化治疗方案,提高治疗的成功率。     

108株幽门螺杆菌（Hp）菌株的耐药分析及其对Hp根除的影响

目的：了解北京地区幽门螺杆菌（Hp）的临床耐药情况以及耐药菌株对Hp根除治疗的影响。方法：对108例Hp阳性患者的临床分离株,采用E-test方法测定幽门螺杆菌对甲硝唑、克拉霉素和阿莫西林的敏感性;并用7d三联疗法或3d四联疗法分别对其中41位十二指肠溃疡患者予幽门螺杆菌根除治疗。结果：108株幽门螺杆菌菌株中,对甲硝唑耐药率为37.0%,对克拉霉素耐药率为13.0%,对其中18株幽门螺杆菌菌株进行了阿莫西林的药物敏感试验,发现1例耐药,7d疗法和3d疗法对幽门螺杆菌敏感株的根除率分别为91.7%及80.0%,耐药株的根除率分别为40.0%及25.0%。结论：幽门螺杆菌对甲硝唑、克拉霉素和阿莫西林均有耐药出现,其中以甲硝唑耐药率最高,克拉霉素的耐药率也呈增高趋势,耐药菌株的出现是导致幽门螺杆菌根除治疗失败的主要原因之一。     

咸宁地区胃疾病患者幽门螺杆菌感染及耐药性分析

目的:探讨咸宁地区胃疾病患者幽门螺杆菌(Helicobacter pylori,Hp)感染及耐药状况.方法:从402例胃疾病患者的胃黏膜活检组织中共分离、鉴定出267株Hp.用Kirby-Baner药敏纸片法检测,Hp对甲硝唑、克拉霉素、阿莫西林、左氧氟沙星、庆大霉素的耐药率.结果:咸宁地区胃疾病患者Hp感染率为66.4%,不同胃疾病、区域之间感染率差异有统计学意义(P＜0.05),不同性别之间感染率差异无统计学意义(P＞0.05),Hp对甲硝唑、克拉霉素、阿莫西林、左氧氟沙星、庆大霉素的耐药率分别为71.5%、11.0%、12.2%、6.2%、2.2%.结论:咸宁地区胃疾病患者Hp感染率较高,其感染率农村高于城市,Hp感染是胃疾病的发生因素.Hp对甲硝唑的耐药性严重,克拉霉素和阿莫西林为本地区根除Hp感染的首选抗菌药物.     

左氧氟沙星对幽门螺杆菌体外抗菌活性的评价

目的 体外试验检测左氧氟沙星对幽门螺杆菌(Helicobacter.pylori)的敏感性，并以克拉霉索和阿莫西林进行对照研究。方法 琼脂稀释法检测左氧氟沙星对52株幽门螺杆菌的最低抑菌浓度，同时比较在MH培养基pH为4．0、5．0、7．0条件下的MIC。结果 左氧氟沙星耐药菌株1．9％，阿莫西林耐药菌株11．5％，克拉霉索耐药菌株25％。同时对阿莫西林和克拉霉索耐药的菌株(9．6％)，对左氧氟沙星均敏感。左氧氟沙星耐药率明显低于克拉霉素(P＜0．01)，阿莫西林的耐药率也低于克拉霉素(P＜0．05)，但与左氧氟沙星的耐药率无明显差异(P＞0．05)。左氧氟沙星在酸性环境下抗菌活性降低。结论 本地区幽门螺杆菌耐药菌株多见，左氧氟沙星是一种可供选择的治疗药物。     

幽门螺杆菌耐药情况及个性化治疗效果分析

目的 探讨黄山市首康医院幽门螺杆菌（HP）阳性患者对不同药物耐药及精准治疗情况,为临床治疗HP提供相关依据。方法 选取2019年3月至2022年3月于该院行14C呼气试验阳性的患者为研究对象,进行HP菌株分离培养,对HP菌株进行药敏实验和耐药基因突变检测,并根据患者性别、年龄进行分组,比较亚组间抗菌药物耐药率、基因突变率差异性。对分离出HP菌株的患者给予精准治疗经验性治疗,比较两组患者HP根除情况。结果 313例患者共分离培养出267例菌株,培养阳性率为85.30%。267例HP菌株对甲硝唑耐药性最高（88.01%）,对阿莫西林（0.00%）、呋喃唑酮（0.00%）、四环素（0.00%）耐药性最低。多重耐药结果显示,甲硝唑+克拉霉素（47.19%）耐药性最高。亚组分析显示,不同年龄患者的甲硝唑、克拉霉素、左氧氟沙星耐药率比较,差异有统计学意义（P<0.05）;基因突变检测结果显示,甲硝唑突变率（100.00%）最高;亚组分析显示,不同性别患者的阿莫西林、左氧氟沙星突变率比较,差异有统计学意义（P<0.05）;不同年龄患者的呋喃唑酮、左氧氟沙星突变率比较,差异有统计学意义（P...     

琼脂稀释法检测5种抗菌药物对幽门螺杆菌的体外抑制效应

目的：探讨临床常用的5种抗菌药物对幽门螺杆菌（Hp）的体外抑制效应,旨在为临床根除Hp提供理论参考。方法：琼脂稀释法测定单药及联合用药对110株临床分离的Hp的最小抑菌浓度（MIC）和联合抑菌分数（FIC）。结果：110株Hp对5种抗菌药物的耐药率,左氧氟沙星为76.4%、克拉霉素为51.8%、替硝唑为20.9%、阿莫西林为8.2%、左奥硝唑为2.7%。5种抗菌药物的二联用药对Hp的抑制效应为：阿莫西林联合克拉霉素/左奥硝唑的协同抑制效应最强,替硝唑联合阿莫西林/左奥硝唑、左氧氟沙星联合阿莫西林/左奥硝唑具有协同抑制效应,克拉霉素联合左奥硝唑具有累加抑菌效应。结论：Hp对左氧氟沙星有较高的耐药性,对克拉霉素和替硝唑有一定的耐药性,对阿莫西林和左奥硝唑较敏感;阿莫西林联合克拉霉素/左奥硝唑对Hp的协同抑制效应最强。对根除Hp的治疗应在药物敏感性试验检测结果下选择性地应用抗菌药物。     

幽门螺杆菌的耐药分析及对Hp根除的影响

目的探讨幽门螺杆菌(Hp)对常用抗菌药的耐药性及对Hp根除的影响,给临床提供合理用药的科学依据.方法采用用改良布氏活性炭培养基(平板)在微需氧环境中培养幽门螺杆菌,并利用琼脂稀释法行幽门螺杆菌的药敏试验.并用三联疗法对62例消化性溃疡进行Hp根除治疗.结果从112例消化性溃疡患者胃黏膜中培养出Hp 62株,对阿莫西林、四环素、克拉霉素、甲硝唑、替硝唑、呋喃唑酮的耐药率分别为1.61%、3.23%、11.2%、58.1%、3.23%、0%.7d根除治疗对Hp的总根除率为:对甲硝唑及克拉霉素敏感株根除率为91.5%,对甲硝唑耐药株根除率为52%,对克拉霉素耐药株根除率为0(P＞0.05).结论阿莫西林、替硝唑、四环素、呋喃唑酮的耐药率较低;而甲硝唑和克拉霉素耐药率较高.其耐药影响Hp根除.     

儿童幽门螺杆菌药敏实验结果及耐药影响因素分析

目的 探讨儿童幽门螺杆菌(HP)药敏实验结果及耐药影响因素。方法 回顾性分析嘉兴市妇幼保健院2015年1月至2020年1月收治的¹³C呼气实验阳性HP感染儿童例临床资料,记录HP耐药情况,同时采用单因素和多因素评价HP耐药独立危险因素。结果 492例患儿中培养出HP菌株共348株,药敏实验结果显示,对克拉霉素、甲硝唑、四环素和阿莫西林均敏感者有2株(占0.57%),单一抗菌药物耐药、双重耐药、三重耐药及四重耐药者分别有150株(占43.10%)、188株(占54.02%)、4株(占1.15%)和4株(1.15%)。Logistic回归模型分析结果显示,既往接受过规范HP根除治疗失败是HP感染患儿克拉霉素耐药发生独立危险因素(OR=0.10,95%CI:0.03～0.29)。结论 HP感染患儿出现克拉霉素、甲硝唑及双重耐药风险较高;既往接受过规范HP根除治疗失败与克拉霉素耐药发生独立相关。     

Hp临床分离株对5种抗生素的耐药性分析

目的:分析Hp临床分离株对5种抗生素的耐药性分析。方法:选取某院消化道症状患者89例的Hp临床分离株,行纸片扩散法检测Hp对5种抗生素的敏感性,并对其进行分析。结果:未经抗Hp治疗患者的Hp对阿莫西林、呋喃唑酮、左氧氟沙星、克拉霉素和甲硝唑的耐药率分别为4.5%、3.4%、37.1%、31.5%和76.4%。经抗Hp治疗与未经抗Hp治疗患者的Hp对甲硝唑耐药率比较,差异不具有统计学意义(P0.05);经抗Hp治疗与未经抗Hp治疗患者的Hp对左氧氟沙星、克拉霉素耐药率比较,差异显著,具有统计学意义(P0.05)。结论:抗Hp5种药物中,Hp对呋喃唑酮和阿莫西林的耐药率较低,可作为根除Hp的首选药物;对左氧氟沙星和克拉霉素的耐药率相对较高,选用时要在药敏检测指导下完成;对甲硝唑的耐药率较高,不可作为一线药物使用。     

雷贝拉唑+克拉霉素+左氧氟沙星三联疗法治疗幽门螺杆菌消化道溃疡的观察

目的：观察雷贝拉唑＋克拉霉素＋左氧氟沙星三联疗法治疗幽门螺杆菌消化道溃疡的疗效。方法：60例幽门螺杆菌阳性消化道溃疡患者随机平分为两组,两组患者都采用三联一周疗法,治疗组为雷贝拉唑＋克拉霉素＋左氧氟沙星治疗,对照组为奥美拉唑＋阿莫西林＋甲硝唑治疗。结果：经过治疗,治疗组30例96.7%的总有效率明显高于对照组70.0%的总有效率（P＜0.05）;治疗组90.0%的HP根除率明显高于对照组66.7%的HP根除率（P＜0.05）。结论：雷贝拉唑＋克拉霉素＋左氧氟沙星三联疗法治疗幽门螺杆菌消化道溃疡能提高疗效,提高HP根除率,值得推广应用。     

High levels of dual resistance to clarithromycin and metronidazole and in vitro activity of levofloxacin against Helicobacter pylori isolates from patients after failure of therapy

Current treatment for Helicobacter pylori infections generally includes two or more antimicrobials (amoxicillin, clarithromycin, nitroimidazoles, tetracycline, etc.), but treatment fails in 10-20% of all cases, often because of drug resistance. Levofloxacin has been proposed as an alternative for these refractory infections. We examined 67 H. pylori isolates from patients unsuccessfully treated with amoxicillin, clarithromycin, metronidazole and levofloxacin. Minimum inhibitory concentrations determined with the epsilometer test revealed clarithromycin and metronidazole resistance in 91 and 82.1% of the isolates, respectively; 52 (77.6%) were resistant to both drugs. All 67 isolates were susceptible to amoxicillin and tetracycline. Fifty-two isolates had levofloxacin MICs of 0.01-2 mg/l; the remaining 15 (22.4%), all clarithromycin- and metronidazole-resistant, had MICs >/= 8 mg/l. Levofloxacin may be an option for refractory H. pylori infections, but the choice should be based on in vitro susceptibility data, and physicians should consider local resistance patterns when treating these infections empirically.     

Lansoprazole, levofloxacin and amoxicillin triple therapy vs. quadruple therapy as second-line treatment of resistant Helicobacter pylori infection

AIM: To test the efficacy of levofloxacin-based second-line therapy for resistant Helicobacter pylori infection. METHODS: One hundred and six patients who failed H. pylori eradication were randomized to receive (i) lansoprazole 30 mg, amoxicillin 1 g, levofloxacin 500 mg, all given twice daily for 7 days (LAL); or (ii) lansoprazole 30 mg twice daily, metronidazole 400 mg thrice daily, bismuth subcitrate 120 mg and tetracycline 500 mg four times daily for 7 days (quadruple). Post-treatment H. pylori status was determined by (13)C-urea breath test. RESULTS: Intention-to-treat and per-protocol H. pylori eradication rates were 57/60% for the LAL group and 71/76% for the quadruple group respectively. Metronidazole, clarithromycin, amoxicillin and levofloxacin resistance were found in 76%, 71%, 0% and 18% of patients, respectively. Levofloxacin resistance led to treatment failure in the LAL group. For patients with dual resistance to metronidazole and clarithromycin, the eradication rates were 79% in the LAL group (levofloxacin-sensitive) and 65% in the quadruple group (P=0.34). CONCLUSION: Lansoprazole, amoxicillin plus levofloxacin second-line therapy is comparable with quadruple therapy in efficacy. Subjects, especially those with dual resistance to metronidazole and clarithromycin, may consider levofloxacin-based therapy for levofloxacin-sensitive strains.     

Recent trends in primary antimicrobial resistance of Helicobacter pylori in Finland

The antimicrobial susceptibility of Helicobacter pylori is an important predictor of the success of eradication therapy. To evaluate recent changes in primary antimicrobial resistance of H. pylori isolated from Finnish patients, the clinical records of H. pylori-positive patients referred for endoscopy to Herttoniemi Hospital (Helsinki, Finland) during 2000-2008 were investigated retrospectively. Stored H. pylori strains from 505 patients without previous eradication therapy were tested for clarithromycin, metronidazole, levofloxacin, tetracycline and amoxicillin susceptibility by Etest. Data on local consumption of antimicrobials were collected and correlations between consumption and resistance were calculated. During the 9-year study period, metronidazole resistance was high (range 29-59%, overall 41%). After an initial increase in clarithromycin resistance (0% in 2000 to 16% in 2003), resistance to clarithromycin decreased to 4% in 2008. No significant correlation was detected between consumption of macrolides and resistance of clarithromycin. Resistance to levofloxacin varied between 0% and 12%. Primary metronidazole resistance in H. pylori is at a high level, however levofloxacin and clarithromycin resistances are still at a reasonable level. Thus, primary clarithromycin resistance in H. pylori in Finland has not become such a problem as in many other countries. Primary resistance to the antimicrobials studied varied considerably from year to year.     

多西环素、左氧氟沙星参与的序贯疗法治疗胃幽门螺旋杆菌感染

目的：研究分析多西环素、左氟氧沙星参与的序贯疗法对胃幽门螺旋杆菌感染（HP）的治疗效果。方法：将我院2014年8月～2015年12月收治的胃幽门螺旋杆菌感染患者120例，分为A组和B组各60例。 A组采用序贯疗法进行治疗，患者前3d服用雷贝拉唑、甲硝唑、阿莫西林，后7d服用雷贝拉唑、多西环素、左氟氧沙星。B组口服雷贝拉唑、甲硝唑、阿莫西林，疗程为10d。统计分析两组患者的症状评分、溃疡面积、疗效以及不良反应发生率。结果：治疗后两组的临床症状及溃疡面积均有所改善，A组的临床症状积分及溃疡面积均显著小于B组（P＜0.05）。A组的总有效率、HP清除率高于B组（P＜0.05）。两组患者不良反应总发生率无差异（P﹥0.05）。结论：多西环素、左氟氧沙星参与的序贯疗法可降低HP的耐药性，提高HP清除率，疗效优于传统疗法，值得推广。     

High efficacy of 1-week doxycycline- and amoxicillin-based quadruple regimen in a culture-guided, third-line treatment approach for Helicobacter pylori infection

BACKGROUND: Helicobacter pylori infection may persist after both first- and second-line current treatments. AIM: To assess the efficacy of a third-line, culture-guided treatment approach for the eradication of H. pylori. METHODS: Patterns of resistance were analysed in H. pylori isolates from 94 consecutive patients in whom H. pylori infection had persisted after two eradication attempts. Using the epsilometer test, susceptibility analysis was performed for amoxicillin, clarithromycin, metronidazole, tetracycline and levofloxacin. Patients were then treated with a culture-guided, third-line regimen: 89 patients with a 1-week quadruple regimen including omeprazole, bismuth, doxycycline and amoxicillin, and five patients with a 1-week triple regimen containing omeprazole, amoxicillin and levofloxacin or clarithromycin. RESULTS : Ninety-four subjects (100%) were resistant to metronidazole, 89 (95%) to clarithromycin, 29 (31%) to levofloxacin and five (5%) to tetracycline. No resistance to amoxicillin was found in any patient. Overall, H. pylori eradication was obtained in 90% of subjects. The quadruple regimen was effective in 81 patients (92% by per protocol and 91% by intention-to-treat analysis). Four patients (80%, both per protocol and intention-to-treat analysis) were H. pylori-negative after the triple regimen. CONCLUSIONS: A culture-guided, third-line therapeutic approach is effective for the eradication of H. pylori. Furthermore, the 1-week doxycycline- and amoxicillin-based quadruple regimen is a good third-line 'rescue' treatment option.     

四种治疗方案对儿童幽门螺杆菌感染的临床疗效观察

目的观察4种治疗方案对根除儿童幽门螺杆菌感染(Helicobacter Pylori,H.pylori)的疗效。方法200例H.pylori感染患儿随机分到4组,疗程均为14 d。A组(52例):奥美拉唑、阿莫西林联合克拉霉素混悬液;B组(51例):奥美拉唑、阿莫西林联合甲硝唑;C组(45例):奥美拉唑、甲硝唑联合克拉霉素混悬液;D组(52例):奥美拉唑、阿莫西林、克拉霉素混悬液联合枸橼酸铋剂。结果四组治疗方案对H.pylori感染根除率的差异有统计学意义(P<0.05)。A组和D组的根除率均大于90%。结论这些方案均有较高的根除率(≥80%),青霉素过敏患儿推荐C方案,奥美拉唑、阿莫西林联合克拉霉素混悬液组为最佳儿童H.pylori感染根除疗法。     

两种三联法治疗十二指肠溃疡并幽门螺杆菌感染的对比研究

目的：评价埃索美拉唑、阿莫西林、左氧氟沙星及埃索美拉唑、克拉霉素、左氧氟沙星两种三联法7d疗程根除十二指肠球部溃疡合并幽门螺杆菌感染的疗效。方法：将92例经电子胃镜诊断为十二指肠球部溃疡、14碳-尿素呼气试验（14C-UBT）Hp阳性患者随机分为两组,即治疗组48例给予埃索美拉唑20mg、阿莫西林1000mg、左氧氟沙星200mg口服,2次/d,共7d;对照组44例给予埃索美拉唑20mg、克拉霉素500mg、左氧氟沙星200mg口服,2次/d,共7d;停服药4周后复查胃镜及14碳-尿素呼气试验,观察溃疡愈合情况以及幽门螺杆菌根除率。结果：治疗组及对照组幽门螺杆菌根除率及十二指肠球部溃疡愈合率分别为93.75%、93.18%和97.92%、97.73%,差异均无统计学意义（P〉0.05）。结论：两种新的三联法治疗方案在治疗十二指肠球部溃疡并Hp感染均有效,不但为探讨多种根除Hp治疗方式提供了临床依据,同时可作为根除十二指肠溃疡Hp再感染复发的一线治疗或失败后的补救治疗方案。