无锡地区儿童幽门螺杆菌耐药性及治疗分析

The antibiotic resistance and treatment strategies of Helicobacter pylori in children in Wuxi

目的分析江苏省无锡地区门诊儿童幽门螺杆菌(Hp)感染及耐药情况,并探讨抗菌药物合理使用策略。方法回顾性分析2018年12月至2021年7月,因上消化道症状在消化内科门诊就诊并行胃镜检查患儿的临床资料。结果采集患儿胃窦黏膜标本716例。其中男392例、女324例;中位年龄11.0(9.0~13.0)岁,≤12岁454例、>12岁262例。Hp培养阳性260例(36.3%),男132例、女128例;≤12岁148例、>12岁112例;>12岁患儿Hp阳性率(42.7%)明显高于≤12岁患儿(32.6%),差异有统计学意义(P<0.05)。药敏试验结果显示,对6种抗菌药物均敏感的菌株占10.4%(27/260),甲硝唑耐药率为75.4%(196/260),克拉霉素耐药率为37.7%(98/260),左氧氟沙星耐药率为20.8%(54/260),未发现对呋喃唑酮、阿莫西林、四环素耐药的菌株;76例对两种抗菌药物耐药,其中克拉霉素+甲硝唑双重耐药45例,克拉霉素+左氧氟沙星双重耐药11例,甲硝唑+左氧氟沙星双重耐药20例;对克拉霉素、甲硝唑和左氧氟沙星三重耐药19例。结论无锡地区儿童Hp培养阳性率随着年龄增长明显上升。Hp对甲硝唑耐药率非常高,经验性治疗避免选择甲硝唑,可考虑四环素、呋喃唑酮替代甲硝唑。

Objective To analyze the infection and drug resistance of Helicobacter pylori(Hp)in outpatients in Wuxi,Jiangsu province,and to explore the strategy of rational use of antibiotics.Methods The clinical data of children who underwent gastroscopy in gastroenterology outpatient department due to upper gastrointestinal symptoms from December 2018 to July 2021 were retrospectively analyzed.Results Gastric antral mucosa samples were collected from 716 children,including 392 boys and 324 girls.The median age was 11.0(9.0-13.0)years,and there were 454 children≤12 years old and 262 children>12 years old.Hp culture was positive in 260 children(36.3%),including 132 boys and 128 girls.There were 148 children≤12 years old and 112 children>12 years old.The positive rate of Hp in children>12 years old(42.7%)was significantly higher than that in children≤12 years old(32.6%),and the difference was statistically significant(P<0.05).The results of drug susceptibility test of 260 Hp strains showed that 10.4%(27/260)of the strains were sensitive to all six antimicrobial agents.The drug resistance rates of metronidazole,clarithromycin and leofloxacin were 75.4%(196/260),37.7%(98/260)and 20.8%(54/260),respectively.No strains resistant to furazolidone,amoxicillin and tetracycline were found.Seventy-six patients were resistant to two antimicrobial agents,including 45 patients with dual resistance to clarithromycin and metronidazole,11 to clarithromycin and levofloxacin,and 20 to metronidazole and levofloxacin.Nineteen children were resistant to clarithromycin,metronidazole and levofloxacin.Conclusions The positive rate of Hp culture in children of Wuxi region increased significantly with age.The drug resistance rate of Hp to metronidazole is very high.Metronidazole should be avoided in empirical treatment,and tetracycline and furazolidone can be considered to replace metronidazole.