Analysis of the current status of Helicobacter pylori infection, antibiotic resistance, and associated factors in patients at a Grade B tertiary hospital
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摘要:
目的 了解本院特定就诊人群中幽门螺杆菌的感染现状与抗生素耐药谱，分析抗生素耐药谱与性别、年龄等因素的关联，为实施本地区个体化抗幽门螺杆菌治疗提供数据基础。 方法 选择2022年1月—2023年2月于浙江省人民医院淳安分院行胃镜检查的214例患者，并采集其胃黏膜标本作Hp培养及药敏测定，分析患者Hp感染现状及其抗生素耐药情况。 结果 214例患者中检测为Hp感染阳性者81例，Hp感染率为37.85%。81株Hp对甲硝唑耐药率最高(76.54%)，其次为阿莫西林(41.98%)、克拉霉素(20.99%)。6种抗生素单药耐药率比较差异有统计学意义(P < 0.001)。81株Hp单一耐药率为39.51%，双重耐药率为32.10%，三重耐药率为17.28%，多重(超过3类)耐药率为3.70%。对甲硝唑单药耐药率中，50~64岁患者的耐药率最高(90.00%)，18~29岁患者的耐药率最低(46.15%)。 结论 本院患者Hp感染率低于全国流行病学调查报告数据，总体耐药率较高，其中对甲硝唑、阿莫西林及克拉霉素的耐药率呈上升趋势；不同年龄患者对甲硝唑单药耐药率存在差异。地区医院应开展药敏试验，并根据实验结果采取措施进行精准Hp根除治疗。 Abstract:Objective To investigate the current status of Helicobacter pylori infection and its antibiotic resistance profile in a specific patient population at our hospital, and to analyze the association between the resistance patterns and factors such as sex and age. The findings aim to provide evidence to support individualized H. pylori eradication therapy in this region. Methods A total of 214 patients who underwent gastroscopy at the Chun'an Branch of Zhejiang Provincial People's Hospital between January 2022 and February 2023 were enrolled. Gastric mucosal specimens were collected from them for Hp culture and drug susceptibility testing to assess the prevalence of Hp infection and antibiotic resistance patterns. Results Among the 214 patients, 81 were tested positive for Hp infection, yielding an Hp infection rate of 37.85%. Among the 81 isolated Hp strains, resistance to six antibiotics were evaluated. The highest resistance rate was observed for metronidazole (76.54%), followed by amoxicillin (41.98%), and clarithromycin (20.99%). The difference in resistance rates among the six antibiotics was statistically significant (P < 0.001). Regarding resistance patterns, 39.51% of strains exhibited single-drug resistance, 32.10% showed dual resistance, 17.28% demonstrated triple resistance, and 3.70% exhibited multiple (over 3 types) resistance. Among patients with metronidazole monoresistance, those aged 50-64 years had the highest resistance rate (90.00%), whereas patients aged 18-29 years had the lowest resistance rate (46.15%). Conclusion The prevalence of Helicobacter pylori infection rate among patients in our hospital is lower than that reported in national epidemiological surveys, while the overall antibiotic resistance rate remains relatively high. The resistance rates to metronidazole, amoxicillin, and clarithromycin show an increasing trend, and age-related differences are observed in metronidazole monoresistance. Regional hospitals should perform susceptibility testing and implement targeted H. pylori eradication strategies based on resistance profiles. -
Key words:
- Helicobacter pylori /
- Antibiotic /
- Drug resistance /
- Bacteria
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表 1 81株Hp对6种抗生素单药耐药情况
Table 1. Resistance profiles of 81 Helicobacter pylori (Hp) strains to six individual antibiotics
抗生素 耐药数(株) 耐药率(%) 甲硝唑 62 76.54 阿莫西林 34 41.98 克拉霉素 17 20.99 左氧氟沙星 8 9.88 呋喃唑酮 5 6.17 四环素 2 2.47 
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表 2 81例Hp感染阳性患者Hp抗生素总体耐药情况
Table 2. Overall resistance of Hp-positive to antibiotics in 81 Hp-positive patients
耐药分类 抗生素 耐药率(%) 对药敏感 7.41(6/81) 单一 甲硝唑 33.33(27/81) 阿莫西林 6.17(5/81) 双重 甲硝唑-阿莫西林 23.46(19/81) 甲硝唑-克拉霉素 8.64(7/81) 三重 甲硝唑-阿莫西林-克拉霉素 13.58(11/81) 甲硝唑-阿莫西林-左氧氟沙星 2.47(2/81) 甲硝唑-克拉霉素-左氧氟沙星 1.23(1/81) 多重 甲硝唑-阿莫西林-克拉霉素-左氧氟沙星 1.23(1/81) 甲硝唑-阿莫西林-克拉霉素-左氧氟沙星-呋喃唑酮 1.23(1/81) 甲硝唑-阿莫西林-克拉霉素-左氧氟沙星-四环素 1.23(1/81)
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表 3 不同性别Hp感染阳性者的抗生素耐药情况比较[例(%)]
Table 3. Comparison of antibiotic resistance in Hp-positive patients by gender [strain (%)]
性别 例数 甲硝唑 阿莫西林 克拉霉素 左氧氟沙星 呋喃唑酮 四环素 男性 45 35(77.78) 18(40.00) 10(22.22) 3(6.67) 4(8.89) 1(2.22) 女性 36 27(75.00) 16(44.44) 7(19.44) 5(13.89) 1(2.78) 1(2.78) χ2值 0.086 0.162 0.093 0.501 0.450 0.314 P值 0.769 0.687 0.760 0.479 0.502 0.575
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表 4 不同性别Hp感染阳性者抗生素总体耐药情况比较[例(%)]
Table 4. Comparison of overall antibiotic resistance in Hp-positive patients by gender [casa (%)]
性别 例数 对药物敏感 单一 双重 三重 多重 男性 45 4(8.89) 18(40.00) 13(28.89) 8(17.78) 2(4.44) 女性 36 2(5.56) 14(38.89) 13(36.11) 6(16.67) 1(2.78) χ2值 0.020 0.010 0.479 0.017 0.039 P值 0.887 0.919 0.489 0.895 0.844
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表 5 不同年龄段Hp感染阳性者的抗生素耐药率比较[例(%)]
Table 5. Comparison of antibiotic resistance rates in Hp-positive patients by age group [case (%)]
年龄 例数 甲硝唑 阿莫西林 克拉霉素 左氧氟沙星 呋喃唑酮 四环素 18~29岁 13 6(46.15) 4(30.77) 2(15.38) 0 1(7.69) 0 30~39岁 21 15(71.43) 8(38.10) 5(23.81) 3(14.29) 2(9.52) 1(4.76) 40~49岁 27 22(81.48) 11(40.74) 9(33.33) 5(18.52) 2(7.41) 1(3.70) 50~64岁 20 18(90.00) 11(55.00) 1(5.00) 0 0 0 χ2值 8.987 2.210 5.911 6.341 1.846 1.465 P值 0.029 0.530 0.116 0.096 0.605 0.690
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表 6 不同年龄阶段Hp感染阳性者的抗生素总体耐药情况[例(%)]
Table 6. Overall antibiotic resistance in Hp-positive patients by age group [case (%)]
年龄 例数 对药物敏感 单一 双重 三重 多重 18~29岁 13 3(23.08) 8(61.54) 2(15.38) 0 0 30~39岁 21 2(9.52) 11(52.38) 6(28.57) 2(9.52) 0 40~49岁 27 1(3.70) 7(25.93) 10(37.04) 8(29.63) 1(3.70) 50~64岁 20 0 6(30.00) 8(40.00) 4(20.00) 2(10.00) χ2值 6.931 6.937 2.661 6.583 3.531 P值 0.074 0.074 0.447 0.086 0.317
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