浙江省台州地区2010-2013年幽门螺杆菌常用抗生素耐药监测

Epidemiological study on antibiotic resistance among Helicobacter pylori in Taizhou district, Zhejiang,2010-2013

目的：了解浙江省台州地区幽门螺杆菌（HP）对常用抗生素的耐药谱。方法收集2010年1月至2013年12月台州市4家医院住院及门诊39099例胃镜检查患者的胃黏膜标本，进行HP分离培养；采用平板掺入法检测分离株对甲硝唑、克拉霉素、阿莫西林、庆大霉素、左氧氟沙星和呋喃唑酮的耐药性。结果共获得HP临床分离株13038株，耐药检测显示，HP对甲硝唑的耐药率＞93%，对阿莫西林、庆大霉素和呋喃唑酮的耐药率＜0.5%。对左氧氟沙星和克拉霉素的耐药率较高，于2011年达到高点，此后耐药率逐年降低（P＜0.01）；左氧氟沙星和克拉霉素的联合耐药率在2011年达到最高（P＜0.01），此后明显下降，但2013年与2012年相比，差异无统计学意义（P＞0.05）。结论台州地区HP分离株对甲硝唑的耐药率最高，对阿莫西林、庆大霉素和呋喃唑酮耐药率较低，临床治疗应选用阿莫西林、庆大霉素和呋喃唑酮。左氧氟沙星和克拉霉素耐药率有下降趋势，但两药的联合耐药率未出现降低，多耐菌株的出现及其原因应引起重视。

Objective To study the infection status of Helicobacter pylori （H. pylori） and sensitivity to commonly used antibiotics in Taizhou district,Zhejiang province. Methods 39 099 cases aged between 5 and 95 years old（mean as 48.42 years）were involved during January 2010 to December,2013 for this study. Sex ratio was 1 ∶ 0.95. Yearly distribution of the number of cases were 5 031,6 709,11 902 and 15 457 in 2010,2011,2012 and 2013,respectively. Gastric mucosal specimens were collected and H. pylori strains were isolated and cultured in the same platform in Zhiyuan Medical Inspection Institute of Hangzhou. Resistance tests of all the H. pylori isolates were performed to 6 commonly used antibiotics：metronidazole,clarithromycin,amoxicillin,gentamicin, levofloxacin and furazolidone with the agar dilution method. The antibiotic resistance rates of H. pylori strains isolated during year 2010-2013 and the changing trends were analyzed. Results Resistance rates to levofloxacin and clarithromycin kept at higher level and the highest was in 2011 and then decreased in both 2012 and 2013 （P0.05）. Conclusion Antibiotic resistance rate against metronidazole for HP isolate was highest. Resistance rate against amoxicillin and furazolidone,gentamicin was low. Clinical treatment should choose amoxicillin and furazolidone,gentamicin. The resistance rates to levofloxacin and clarithromycin had been seen at a significantly downwarding trend since 2011. However,the combined resistance rates to levofloxacin and clarithromycin did not seem to reduce since 2012.