武汉地区2018—2019年幽门螺杆菌菌株耐药性分析

目的 研究武汉地区幽门螺杆菌(Hp)菌株对常用抗生素的体外敏感性及耐药性。方法 选取2018年1月至2019年12月湖北省中医院光谷院区消化内镜中心13C或14C呼气试验确诊的Hp患者为研究对象,共652例。取其胃黏膜活检标本行Hp培养,对Hp培养阳性患者的Hp菌株进行体外抗菌药物敏感性试验,检测Hp对甲硝唑、克拉霉素、左氧氟沙星、阿莫西林、呋喃唑酮、四环素的敏感性。结果 Hp培养阳性患者为430例,阳性率为65.95%,其对甲硝唑、克拉霉素、左氧氟沙星耐药率较高,分别为80.70%、34.42%、26.51%,对阿莫西林、呋喃唑酮、四环素耐药率较低;单一耐药178株,其中,甲硝唑单一耐药156株(占36.28%);多重耐药204株(占47.44%),其中,双重耐药152株(占35.35%);三重耐药49株(占11.40%);四重耐药仅3株(占0.69%)。根据Hp培养结果,精准四联组和经验四联组根除率比较,差异有统计学意义(P0.05)。结论 武汉地区Hp对甲硝唑、克拉霉素、左氧氟沙星的耐药率较高,且多重耐药性较复杂,建议武汉地区Hp治疗可选用四环素、呋喃唑酮、阿莫西林,或根据培养结果选择精准四联疗法。

Analysis of drug resistance of Helicobacter pylori strains in Wuhan region from 2018 to 2019

Objective To investigate the in vitro sensitivity and drug resistance of Helicobacter pylori (Hp) strains to commonly used antibiotics in Wuhan region.Methods A total of 652 Hp patients diagnosed by 13C or 14C breath test in the Digestive Endoscopy Center of Guanggu Branch of Hubei Provincial Hospital of Traditional Chinese Medicine from January 2018 to December 2019 were selected as the research objects.The gastric mucosa biopsy specimen was cultured with Hp,and the Hp strains of patients with positive Hp culture were tested for antimicrobial susceptibility in vitro.The sensitivities of Hp to metronidazole,clarithromycin,levofloxacin,amoxicillin,furazolidone and tetracycline were detected.Results There were 430 patients with positive Hp culture,accounting for a positive rate of 65.95%.The drug resistance rates to metronidazole,clarithromycin and levofloxacin were 80.70%,34.42% and 26.51%,respectively,while the drug resistance rates to amoxicillin,furazolidone and tetracycline were low.There were 178 strains with single drug resistant,among which there were 156 strains with single drug resistant to metronidazole(accounting for 36.28%).There were 204 strains with multi-drug resistant (accounting for 47.44%),among which there were 152 strains with dual drug resistant(accounting for 35.35%),there were 49 strains with triple drug resistant (accounting for 11.40%),and there were only 3 strains with quadruple drug resistance(accounting for 0.69%).According to the results of Hp culture,the eradication rate in the precise quadruple therapy group was significantly higher than that in the empirical quadruple therapy group,with statistically significant difference (P<0.05).Conclusion The drug resistance rate of Hp to metronidazole,clarithromycin and levofloxacin in Wuhan region are high,and the multi-drug resistance is complex.It is suggested that tetracycline,furazolidone and amoxicillin or precise quadruple therapy should be selected for Hp therapy in Wuhan region.