Refractoriness to anti-Helicobacter pylori treatment attributed to phenotypic resistance patterns in patients with gastroduodenopathy in Guayaquil-Ecuador

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2024-04-05 DOI:10.1111/hel.13060

Javier David Lara Icaza, Rosalina Lara Tapia, Cástula Tania Castro Triana, Laura Catalina Romero Ramírez

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Abstract

Background

Treatment of Helicobacter pylori gastric infection is complex and associated with increased rates of therapeutic failure. This research aimed to characterize the H. pylori infection status, strain resistance to antimicrobial agents, and the predominant lesion pattern in the gastroduodenal mucosa of patients with clinical suspicion of refractoriness to first- and second-line treatment who were diagnosed and treated in a health center in Guayaquil, Ecuador.

Methods

A total of 374 patients with upper gastrointestinal symptoms and H. pylori infection were preselected and prescribed one of three triple therapy regimens for primary infection, as judged by the treating physician. Subsequently, 121 patients who returned to the follow-up visit with persistent symptoms after treatment were studied.

Results

All patients had H. pylori infection. Histopathological examination diagnosed chronic active gastritis in 91.7% of cases; premalignant lesions were observed in 15.8%. The three triple therapy schemes applied showed suboptimal efficacy (between 47.6% and 77.2%), with the best performance corresponding to the scheme consisting of a proton pump inhibitor + amoxicillin + levofloxacin. Bacterial strains showed very high phenotypic resistance to all five antimicrobials tested: clarithromycin, 82.9%; metronidazole, 69.7%; amoxicillin and levofloxacin, almost 50%; tetracycline, 38.2%. Concurrent resistance to clarithromycin–amoxicillin was 43.4%, to tetracycline–metronidazole 30.3%, to amoxicillin–levofloxacin 27.6%, and to clarithromycin–metronidazole 59.2%.

Conclusions

In vitro testing revealed resistance to all five antibiotics, indicating that H. pylori exhibited resistance phenotypes to these antibiotics. Consequently, the effectiveness of triple treatments may be compromised, and further studies are needed to assess refractoriness in quadruple and concomitant therapies.

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瓜亚基尔-厄瓜多尔胃十二指肠病患者因表型耐药模式而对幽门螺杆菌抗生素治疗产生的耐药性

背景幽门螺杆菌胃感染的治疗非常复杂，且治疗失败率较高。本研究旨在分析在厄瓜多尔瓜亚基尔市一家医疗中心接受诊断和治疗的幽门螺杆菌感染状况、菌株对抗菌药的耐药性以及临床怀疑对一线和二线治疗无效的患者胃十二指肠粘膜的主要病变模式。方法预选了374名有上消化道症状和幽门螺杆菌感染的患者，并根据主治医生的判断，为他们开出了治疗原发性感染的三种三联疗法中的一种。随后，研究了 121 名在治疗后因症状持续而复诊的患者。结果所有患者均感染了幽门螺杆菌。经组织病理学检查，91.7%的病例确诊为慢性活动性胃炎；15.8%的病例出现癌前病变。三种三联疗法的疗效均不理想（介于 47.6% 和 77.2% 之间），其中质子泵抑制剂+阿莫西林+左氧氟沙星的疗效最好。细菌菌株对测试的所有五种抗菌药都表现出极高的表型耐药性：克拉霉素，82.9%；甲硝唑，69.7%；阿莫西林和左氧氟沙星，近 50%；四环素，38.2%。同时对克拉霉素-阿莫西林产生耐药性的占 43.4%，对四环素-甲硝唑产生耐药性的占 30.3%，对阿莫西林-左氧氟沙星产生耐药性的占 27.6%，对克拉霉素-甲硝唑产生耐药性的占 59.2%。结论体外测试显示，幽门螺杆菌对所有五种抗生素都具有耐药性，表明幽门螺杆菌对这些抗生素具有耐药表型。因此，三联疗法的效果可能会受到影响，还需要进一步研究来评估四联疗法和并用疗法的耐药性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.