幽门螺杆菌抗生素耐药趋势研究：2000年到2009年 中国上海

The Evolution of Helicobacter pylori Antibiotics Resistance Over 10Years in Beijing,China

Wen Gao,*,1Hong Cheng,*,1Fulian Hu,*Jiang Li,*Lihui Wang,*Guibin Yang,†Le Xu‡and Xiaoli Zheng‡

*Department of Gastroenterology,Peking University First Hospital,Beijing,China,†Department of Gastroenterology,Aerospace Clinical College of Peking University,Beijing,China,‡Department of Gastroenterology,Beijing Hospital,Beijing,China

Helicobacter pylori is a Gram-negativeflagellated spiral bacteria.Infection with H.pylori is mainly acquired in childhood.H.pylori infection is recognized as a causal factor in the pathogenesis of chronic gastritis,peptic ulcer,gastric cancer,and gastric MALT lymphoma.

H.pylori eradication treatment is indicated in patients with peptic ulcer disease,MALToma,atrophic gastritis, post-gastric cancer resection,or patients who arefirst-degree relatives of patients with gastric cancer[1]. Among numerous eradication regimens,a proton pump inhibitor and combination of two antibiotics(amoxicil-lin,clarithromycin,and metronidazole)are considered to be the most effective andfirst-line therapy regimens recommended by Maastricht III Consensus and in China[1,2].However,antibiotic resistance of H.pylori, especially to clarithromycin and metronidazole, strongly undermined the efficacy of eradication treat-ment.The reported frequencies of resistance to anti-biotics varied widely between geographic regions.A European study involving17countries and1274H.pylori isolates showed a mean resistance rate(deter-mined by E-test)to amoxicillin0.8%;to clarithromycin 9.9%;and to metronidazole33.1%[3].Another recent study from French examined530H.pylori strains iso-lates from2004to2007,among those,26%(138⁄530) strains were resistant to clarithromycin,61% (324⁄530)to metronidazole,and13.2%(70⁄530)to ciprofloxacin,whereas no resistance against amoxicillin and tetracycline was observed[4].As culture-based antimicrobial susceptibility data are not always avail-able and the H.pylori eradication regimen especially antibiotics involved should be chosen based on local resistant epidemiologic data and an empirical basis,it is important to understand the regional antibiotics resis-tance status and trend of this bacterium.The aim of this study was to assess the prevalence of antibiotics (amoxicillin,clarithromycin,metronidazole,tetracy-cline,levofloxacin,and moxifloxacin)resistance of H.pylori strains isolated from Beijing in recent 10years.

Keywords

Helicobacter pylori,antibiotic resistance, amoxicillin,clarithromycin,metronidazole, tetracycline,levofloxacin,moxifloxacin.

Reprint requests to:Fulian Hu,Professor, Department of Gastroenterology,Peking University First Hospital,Beijing100034, China.E-mail:hufulian@

1These authors contributed equally to the study.

Supported by Beijing Medicine Research and Development Fund(No.2005-1008).Abstract

Objectives:To evaluate Helicobacter pylori antibiotics resistance evolution from2000to2009to amoxicillin,clarithromycin,metronidazole,tetra-cycline,levofloxacin and moxifloxacin in Beijing,China.

Methods:A total of374H.pylori strains isolated from374subjects who had undergone upper gastrointestinal endoscopy from2000to2009were collected and examined by E-test method for antibiotics susceptibility. Results:The average antibiotics resistance rates were0.3%(amoxicillin), 37.2%(clarithromycin),63.9%(metronidazole),1.2%(tetracycline),50.3% (levofloxacin)and61.9%(moxifloxacin).Overall resistance to clarithro-mycin,metronidazole,andfluoroquinolone increased annually(from14.8 to65.4%,38.9to78.8%,and27.1to63.5%,in2000or2006–2007to 2009,respectively).The secondary resistance rates were much higher than primary rates to these antibiotics,which also increased annually in recent 10years.

Conclusions:The trend of clarithromycin,metronidazole,andfluoroquino-lone resistance of H.pylori increased over time and the resistance to amoxi-cillin and tetracycline was infrequent and stable in Beijing.Clarithromycin, metronidazole,andfluoroquinolone should be used with caution for H.pylori eradication treatment.

Helicobacter ISSN1523-5378