浙江萧山地区幽门螺杆菌耐药趋势:基于5万余菌株抗生素耐药数据分析

Trends in Helicobacter pylori resistance in Xiaoshan,Zhejiang:based on antibiotic resistance analysis of more than 50000 strains

目的回顾性分析2013—2020年萧山地区幽门螺杆菌(Helicobacter pylori,Hp)耐药情况,为该地区根除Hp临床抗生素选择提供合理依据。方法收集2013年1月—2020年12月杭州市萧山区第一人民医院就诊患者分离的非重复Hp及药敏结果。以每10岁作为一个年龄组分组,分析Hp在不同年龄组人群的耐药情况及变化趋势。结果分离培养获得Hp菌株54912株。Hp对4种常见抗生素耐药率为:阿莫西林0.42%、甲硝唑92.94%、克拉霉素22.41%、左氧氟沙星29.83%。克拉霉素和左氧氟沙星的耐药率均呈逐年上升趋势。左氧氟沙星、克拉霉素和甲硝唑耐药率整体随年龄增长而增大。女性克拉霉素、左氧氟沙星和甲硝唑耐药率均高于男性,21~60岁年龄段更为明显。20岁以下人群克拉霉素耐药率明显较高,2017—2019年20岁以下人群阿莫西林耐药率高于其他人群。2020年70岁以上人群左氧氟沙星和克拉霉素耐药率超过57%,且增速较快。结论萧山地区Hp对左氧氟沙星、克拉霉素及甲硝唑的耐药率都处于较高水平,建议根除Hp采用个体化治疗方案,此外对低、高年龄段人群应重点关注。

Objective To analyze Helicobacter pylori(Hp)resistance in Xiaoshan area from 2013 to 2020 and to provide reference for the selection of clinical antibiotics for the eradication of Hp in this area.Methods Non-repetitive Hp strains isolated from patients treated in the First People′s Hospital of Xiaoshan District,Hangzhou from January 2013 to December 2020 and the drug susceptibility test results of these strains were collected.The patients were grouped by every 10 years of age to analyze the drug resistance of Hp in different groups and its changing trends.Results A total of 54912 Hp strains were isolated and cultured.The resistance rates of Hp isolates to amoxicillin,metronidazole,clarithromycin and levofloxacin were 0.42%,92.94%,22.41%and 29.83%,respectively.The drug resistance rates to clarithromycin and levofloxacin were increasing year by year.The resistance rates to levofloxacin,clarithromycin and metronidazole increased with age.The resistance rates to clarithromycin,levofloxacin and metronidazole in women were higher than those in men,especially in the 21-60 age group.The resistance rate to clarithromycin was significantly higher in people under 20 years old.In 2017 to 2019,the resistance rate to amoxicillin was higher in people under 20 years old than in other age groups.In 2020,the resistance rates to levofloxacin and clarithromycin in people over 70 years old both exceed 57%and increased rapidly.Conclusions The resistance rates of Hp to levofloxacin,clarithromycin and metronidazole in Xiaoshan area were all at a high level.It was recommended to use individualized treatments for the eradication of Hp.In addition,attention should be paid to the young and older people.