2009年—2013年浙江嘉兴地区幽门螺杆菌对常用抗菌药物的耐药研究  

Resistance of Helicobacter pylori to Commonly Used Antibiotics in Jiaxing Area,Zhejiang Province from 2009 to 2013

作　　者：韩丰[1] 冀子中[1] 金夏[1] 万里[1] 蔡陈效[1] 陈一鹏[1] 陈红亚[1] 陈敏芳[1] 

机构地区：[1]浙江省嘉兴市第一医院消化科,314000

出　　处：《胃肠病学》2016年第6期353-357,共5页Chinese Journal of Gastroenterology

基　　金：浙江省省市共建医学扶植重点学科计划(GJJX010-002);嘉兴市科技计划项目(2013AY21055)

摘　　要：背景:幽门螺杆菌(Hp)对抗菌药物耐药是导致根除治疗失败最主要的原因。Hp对常用抗菌药物的耐药性存在较大地区差异,了解某一地区的Hp耐药情况,对于提高该地区Hp根除率具有重要指导作用。目的:了解浙江嘉兴地区临床分离Hp菌株对常用抗菌药物的耐药情况。方法:纳入2009年1月—2013年12月在嘉兴市第一医院行胃镜检查的患者17 402例,取胃窦黏膜标本行Hp培养,对分离培养得到的菌株进行甲硝唑、阿莫西林、庆大霉素、呋喃唑酮、克拉霉素和左氧氟沙星药敏试验。结果:17 402例胃黏膜标本中5 898例(33.9%)Hp培养阳性。药敏试验显示各年度、各年龄段甲硝唑单药耐药率均极高,克拉霉素、左氧氟沙星耐药率呈逐年上升趋势,呋喃唑酮、阿莫西林、庆大霉素耐药率均较低。抗菌药物组合中阿莫西林+庆大霉素组合耐药率最低,其次为阿莫西林+呋喃唑酮和庆大霉素+呋喃唑酮组合。结论:浙江嘉兴地区各年龄段临床分离Hp菌株对甲硝唑均有极高的耐药率,不宜作为一线治疗选择。阿莫西林+庆大霉素/呋喃唑酮对不同年龄段患者均是理想的抗菌药物组合,对青霉素过敏者则推荐使用庆大霉素+呋喃唑酮组合。Background： Resistance of Helicobacter pylori （Hp） to antibiotics is the primary reason for failure of Hp eradication therapies. It has been reported that there are regional differences in the resistance rate of Hp to commonly used antibiotics. Monitoring the regional Hp resistance status is helpful for improving the eradication rate in local area. Aims： To investigate the resistant spectrum of clinical Hp strains to commonly used antibiotics in Jiaxing Area, Zhejiang Province. Methods： A total of 17 402 patients who underwent gastroscopy from Jan. 2009 to Dec. 2013 at Jiaxing First Hospital were recruited for Hp culturing by using gastric antral biopsies. Then a drug sensitive test was performed for the Hp strains obtained from the culturing. Sensitivity of these Hp strains to metronidazole, amoxicillin, gentamicin, furazolidone, clarithromycin and levofloxacin was determined. Results： Among the 17 402 cases of gastric antral biopsies, 5 898 （33.9%） were positive for Hp culturing. Drug sensitive test revealed that the resistance rate of metronidazole was extremely high in all year and age groups; the resistance rates of clarithromycin and levofloxacin were increasing by years; and the resistance rates of furazolidone, amoxicillin and gentamicin were considerably low in all year and age groups. When two antibiotics were combined, amoxicillin and gentamicin accounted for the lowest resistance rate, and the next were amoxicillin and furazolidone, and gentamicin and furazolidone, respectively. Conclusions： The clinical Hp strains isolated from all age groups in Jiaxing Area, Zhejiang Province are highly resistant to metronidazole, therefore it is not recommended to be used in first line eradication regimen. Amoxicillin combined with gentamicin/furazolidone is an ideal antibiotic combination for patients with Hp infection in all age groups; and combination of gentamicin and furazolidone is recommended to patients who are allergic to penicillin.

关 键 词：幽门螺杆菌 抗菌药 抗药性 细菌 微生物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]