幽门螺杆菌根除失败后的耐药情况分析

Analysis of the secondary resistance in Helicobacter pylori

目的调查幽门螺杆菌(Hp)对6种常用抗生素的继发耐药情况,为临床医师合理选用抗生素、合理制订根除Hp治疗的补救方案提供依据。方法随机选取深圳市龙华区人民医院Hp根除治疗后行13C呼气试验阳性的患者120例,胃镜下于胃窦小弯侧及胃体小弯侧各取黏膜一块行Hp分离培养,对获得的Hp菌株进行阿莫西林、克拉霉素、呋喃唑酮、多西环素、左氧氟沙星、甲硝唑的药物敏感性试验。结果成功分离培养出97株Hp,快速尿素酶试验阳性者均成功培养出Hp,Hp培养阳性率与性别、年龄、13C呼气试验无相关性(P>0.05)。Hp对甲硝唑、阿莫西林、克拉霉素、呋喃唑酮的继发耐药率分别为100.0%、75.2%、30.9%和1.0%,未检出对多西环素或左氧氟沙星耐药的菌株;单药耐药率为14.4%,双重耐药率为65.0%,三重耐药率为19.6%,四重耐药率为1.0%。Hp继发耐药率与性别、年龄、13C呼气试验结果无相关性(P>0.05)。结论Hp根除治疗的补救方案应在药敏试验指导下进行个体化根除治疗,快速尿素酶试验阳性是提高Hp培养阳性率的可靠方法。

Objective To investigate the secondary drug resistance of Helicobacter pylori(Hp)to six commonly used antibiotics,and to provid a basis for clinicians to rationally choose antibiotics and rationally formulate remedial plans for eradication of Hp.Methods A total of 120 patients with positive 13C breath test after Hp eradication were randomly selected from the Longhua District People′Hospital of Shenzhen City.Gastroscopy was performed on the mucosa of the gastric antrum and on the minor curvature of the gastric body for Hp isolation and culture.The obtained Hp strain was tested for the drug sensitivity of Amoxicillin,Clarithromycin,Furazolidone,Doxycycline,Levofloxacin,Metronidazole.Results A total of 97 strains of Hp were successfully isolated and cultured,and those who were positive for the rapid urease test were successfully cultured.The positive rate of Hp culture were not related to gender,age,and 13C-urea breath test(P>0.05).The secondary drug resistance rates of Hp to Metronidazole,Amoxicillin,Clarithromycin and Furazolidone were 100.0%,75.2%,30.9%,and 1.0%,respectively.No strains resistant to Doxycycline or Levofloxacin were detected;the single drug resistance rate was 14.4%,the dual drug resistance rate was 65.0%,the triple drug resistance rate was 19.6%,while the quadruple drug resistance rate was 1.0%.Hp secondary resistance rates were not related to gender,age,and 13C-urea breath test results(P>0.05).Conclusion The remediation eradication of Hp should be individualized eradication treatment under the guidance of drug susceptibility test.Positive urease test is a reliable method to increase the positive rate of Hp culture.