幽门螺杆菌感染患者耐药的危险因素分析

Analysis of Risk Factors of Drug Resistance in Patients With Helicobacter pylori Infection

背景:幽门螺杆菌(Hp)对抗菌药物的耐药性不断增加,已成为导致其根除率降低的主要因素。目的:探讨影响Hp耐药性的危险因素。方法:回顾性分析2016年12月—2021年3月陆军特色医学中心收治的396例Hp感染患者的相关资料。采用药敏试验评估患者对6种抗菌药(甲硝唑、克拉霉素、左氧氟沙星、阿莫西林、四环素、呋喃唑酮)的耐药情况。应用非条件Logistic回归分析探讨影响Hp耐药性的危险因素。结果:396例Hp感染患者中,对甲硝唑、克拉霉素、左氧氟沙星、阿莫西林、四环素、呋喃唑酮的耐药率分别为96.5%、45.5%、41.9%、0.3%、0.3%、0。多因素分析表明,既往方案使用过克拉霉素为克拉霉素耐药的危险因素(P<0.001),年龄>40岁为左氧氟沙星耐药的危险因素(P<0.001)。结论:甲硝唑、克拉霉素和左氧氟沙星的耐药率较高,在没有药敏试验结果支持的情况下应避免使用含上述抗菌药物的方案,特别是既往方案使用过克拉霉素或年龄>40岁的患者,经验性治疗应优先考虑使用阿莫西林、四环素和呋喃唑酮。

Background:The increasing in antibiotic resistance of Helicobacter pylori(Hp)has become the main cause leading to the decreasing of the eradication rate for Hp treatment.Aims:To investigate the risk factors of drug resistance of Hp.Methods:Data on 396 patients with Hp infection from Dec.2016 to Mar.2021 at Army Medical University were retrospectively analyzed.Drug susceptibility test was used to evaluate the resistance of 6 antibacterial drugs(metronidazole,clarithromycin,levofloxacin,amoxicillin,tetracycline and furazolidone).Unconditional Logistic regression was used to investigate the risk factors affecting Hp antibiotic resistance.Results:In 396 patients with Hp infection,the resistance rates of metronidazole,clarithromycin,levofloxacin,amoxicillin,tetracycline and furazolidone were 96.5%,45.5%,41.9%,0.3%,0.3%and 0,respectively.Multivariate analysis showed that previous regimen containing clarithromycin was a risk factor for clarithromycin resistance(P<0.001),and age>40 years old was a risk factor for levofloxacin resistance(P<0.001).Conclusions:The resistance rates of metronidazole,clarithromycin and levofloxacin are relatively high,and regimens containing these antibiotics should be avoided without the support from drug susceptibility results,especially in patients who have accepted clarithromycin‑containing regimen or more than 40 years old.Amoxicillin,tetracycline and furazolidone should be recommended preferentially for Hp treatment empirically.