2019-2020年上海地区儿童幽门螺杆菌感染及其耐药性分析

Drug resistance of Helicobacter pylori among children in Shanghai from 2019 to 2020

为分析2019—2020年上海地区儿童幽门螺杆菌感染及其对4种常用抗菌药物的耐药状况,本研究收集了2019年1月—2020年10月于复旦大学附属儿科医院就诊且经胃镜检查、快速尿素酶试验阳性的患儿1605例,取胃黏膜样本进行幽门螺杆菌分离培养及鉴定,采用E-test法进行体外药敏试验,分析不同年龄组患儿幽门螺杆菌耐药状况。结果显示,本研究入组患儿标本的幽门螺杆菌分离率为31.5%(506/1605),无性别和年龄差异。幽门螺杆菌临床分离株对甲硝唑、克拉霉素、左氧氟沙星、阿莫西林的耐药率分别为42.3%、25.1%、8.1%、3.0%。除13~16岁组幽门螺杆菌对克拉霉素的耐药率显著高于1~3岁组(31.2%vs.13.3%,P=0.040)外,其他各年龄和性别组之间耐药率均无统计学差异。此外,幽门螺杆菌对克拉霉素+甲硝唑的双重耐药率为18.0%,显著高于对克拉霉素+左氧氟沙星(5.1%)、甲硝唑+左氧氟沙星(4.9%)、甲硝唑+阿莫西林(1.4%)和阿莫西林+左氧氟沙星的耐药率(0.8%)(χ^(2)=172.706,P<0.01)。多重耐药分析显示,幽门螺杆菌对左氧氟沙星+克拉霉素+甲硝唑的耐药率为3.0%,显著高于对左氧氟沙星+阿莫西林+克拉霉素(0.6%)、阿莫西林+甲硝唑+左氧氟沙星的耐药率(0.6%)(χ^(2)=13.907,P=0.01)。结果提示,2019——2020年从上海地区儿童分离的幽门螺杆菌对甲硝唑、克拉霉素的耐药率较高,对阿莫西林和左氧氟沙星的耐药率较低,对甲硝唑和克拉霉素的双重耐药率较高。

The present paper aims to analyze the resistance of Helicobacter pylori(H.pylori)infected by children in Shanghai from 2019 to 2020 to four commonly used antibacterial drugs.From January 2019 to October 2020,1605 children who came to Children’s Hospital of Fudan University in Shanghai and received gastroscopy and rapid urease test were selected.Gastric mucosal membrane samples were collected for H.pylori isolation,culture and identification.In vitro drug susceptibility test by E-test method was used to analyze H.pylori resistance in children in different age groups.The results showed that the overall positive rate of H.pylori of the enrolled children was 31.5%(506/1605),and there was no difference in gender and age.The resistance rates of clinical H.pylori isolates to metronidazole,clarithromycin,levofloxacin,and amoxicillin were 42.3%,25.1%,8.1%,and 3.0%,respectively.Except that the resistance rate of H.pylori to clarithromycin in children aged 13-16 years(31.2%)was significantly higher than that of children aged 1-3 years(13.3%)(P=0.040),there was no difference in age and gender.In addition,the double resistance rate of H.pylori to clarithromycin+metronidazole was 18.0%,which was significantly higher than that to clarithromycin+levofloxacin(5.1%),metronidazole+levofloxacin(4.9%),metronidazole+amoxicillin(1.4%)and amoxicillin+levofloxacin(0.8%)(χ^(2)=172.706,P<0.01).Multi-drug resistance analysis showed that the resistance rate of H.pylori to levofloxacin+clarithromycin+metronidazole was 3.0%,which was significantly higher than that to levofloxacin+amoxicillin+clarithromycin(0.6%),amoxicillin+metronidazole+levofloxacin(0.6%)(χ^(2)=13.907,P=0.01).It is suggested that H.pylori isolated from children in Shanghai from 2019 to 2020 has a higher resistance rate to metronidazole and clarithromycin,a lower resistance rate to amoxicillin and levofloxacin,and a higher dual resistance rate to metronidazole and clarithromycin.