2012至2014年上海地区儿童幽门螺杆菌感染及其耐药性分析

摘要

目的：分析上海地区儿童感染的幽门螺杆菌（Hp）对5种根除治疗方案中常用抗菌药物的耐药情况。方法选取因上消化道症状行胃镜检查、快速尿素酶试验阳性的患儿743例，取胃黏膜活检样本分离培养Hp。药物敏感性试验采用纸片扩散法。将患儿按性别和年龄[学龄前（≤6岁）和学龄期（7～15岁）]分别分组，比较各组分离的Hp对甲硝唑、克拉霉素、阿莫西林、左氧氟沙星和莫西沙星的耐药率。结果743例患儿中分离培养出359株Hp，平均分离率为48.3%。Hp临床分离株对甲硝唑、克拉霉素、阿莫西林、左氧氟沙星和莫西沙星的耐药率分别为49.9%、36.8%、5.3%、5.6%和7.8%。男、女患儿之间5种抗菌药物的耐药率差异均无统计学意义（P>0.05）。学龄前患儿分离的Hp对甲硝唑和阿莫西林的耐药率（74.1%和11.1%）明显高于学龄期患儿（42.8%和3.6%，P值分别为0.000和0.008），而学龄前患儿克拉霉素的耐药率（22.2%）明显低于学龄期患儿（41.0%，P=0.002）。结论上海地区儿童分离的Hp对甲硝唑和克拉霉素的耐药率较高，而对阿莫西林、左氧氟沙星和莫西沙星较为敏感。首次治疗应在体外药物敏感性试验的指导下选择有效的抗菌药物。%ObjectiveTo investigate the drug resistance ofHelicobacter pylori(Hp) to 5 antimicrobial agents,which are commonly used in eradication therapy among children in Shanghai.MethodsGastric mucosa biopsy specimens were collected from pediatric patients who had upper gastrointestinal symptoms,and were diagnosed as having Hp infection by rapid urease test. Hp was determined for drug susceptibility by Kirby-Bauer method. All pediatric patients were classified according to sex and age [preschool-age(0-6 years old)and school-age(7-15 years old)],and the drug resistance rates of Hp to metronidazole,clarithromycin,amoxicillin, levofloxacin and moxifloxacin among these groups were compared.ResultsA total of 359 isolates of Hp were isolated from 743 pediatric patients. The positive rate was 48.3%. The drug resistance rates to metronidazole, clarithromycin,amoxicillin,levofloxacin and moxifloxacin were 49.9%,36.8%,5.3%,5.6% and 7.8%, respectively. No statistical significance in drug resistance rates to the 5 antimicrobial agents was found between boys and girls(P>0.05). The drug resistance rates of isolates from preschool-age group tometronidazole and amoxicillin (74.1% and 11.1%) were higher than those from school-age group(42.8% and 3.6%,P=0.000 and 0.008), while isolates against clarithromycin showed an inverse pattern(22.2% in preschool-age group and 41.0% in school-age group,P=0.002).ConclusionsThe drug resistance rates of Hp among children in Shanghai are high to metronidazole and clarithromycin. However,the drug resistance rates are low to amoxicillin,levofloxacin and moxifloxacin. Therefore,drug susceptibility should be determined before the 1st time therapy.