目的：了解浙江省丽水地区幽门螺杆菌（HP）对常用抗生素的耐药性状况，为提高该地区HP感染的根除率提供依据。方法对2012年3月至2014年2月丽水地区6家医院12834例胃病患者的胃黏膜标本进行HP分离培养及鉴定，并通过耐药临界点药物琼脂稀释法检测HP菌株对左氧氟沙星、甲硝唑、克拉霉素、阿莫西林、庆大霉素及呋喃唑酮的耐药性。结果共纳入12834例患者，HP的总体率为54.70%。其中甲硝唑、左氧氟沙星、克拉霉素的耐药率分别为94.4%、19.76%、16.61%，阿莫西林、庆大霉素及呋喃唑酮的耐药率均为0%。在这些HP临床分离株中还存在大量的多重耐药株，其中左氧氟沙星和甲硝唑的交叉耐药率为18.56%、左氧氟沙星和克拉霉素的交叉耐药率为7.35%、甲硝唑和克拉霉素的交叉耐药率为15.47%，而左氧氟沙星、甲硝唑和克拉霉素的三重耐药株比率为6.92%。结论丽水地区HP临床分离株对甲硝唑的耐药率最高，对左氧氟沙星和克拉霉素的耐药率也达到了较高水平，而对阿莫西林、庆大霉素及呋喃唑酮则均未检测到HP耐药株，因此为提高临床上首次治疗的根除率该地区应首选阿莫西林、庆大霉素和呋喃唑酮作为一线治疗药物，且由于该地区HP对甲硝唑普遍耐药，甲硝唑在该地区已不适合作为HP根除治疗用药。%ObjectiveTo study the infection status of Helicobacter pylori(H. pylori)and sensitivity for commonly used antibiotics and provide reference for improvement of eradication rate of HP infection.MethodsFrom March 2012 to February 2014,12834 patients from 6 hospitals in Lishui district underwent gastrointestinal endoscopy. Gastric mucosal specimens were collected and H. pylori strains were isolated and cultured. Resistance tests of all the H. pylori isolates were performed to 6 commonly used antibiotics:levofloxacin,metronidazole,clarithromycin,amoxicillin,gentamicin, and furazolidone with the agar dilution method.Results12834 cases were enrolled in this study and the overall infection rate of Hp was 54.7%. The resistance rate to metronidazole,levofloxacin and clarithromycin were 94.4%,19.76%,16.61% respectively. The resistant rates of amoxicillin, gentamicin and furazolidone were 0%. There were a large number of multi drug resistant strains in these HP clinical isolates. The resistance rates of isolates obtained during 2012 to 2014 were18.56%,7.35%,15.47%,6.92% to levofloxacin and metronidazole,levofloxacina and clarithromycin, metronidazole and clarithromycin,levofloxacin、metronidazole and clarithromycin,respectively.ConclusionThe metronidazole resistance rates have been maintained at a high level of 94.4 %,the rates of resistance to levofloxacin and clarithromycin also have reached a relative high level. The isolates obtained were sensitive to the following three drugs:amoxicillin,gentamicin,and furazolidone. In order to improve the HP eradication rate of currently accepted triple therapy. Amoxicillin,gentamicin and furazolidone should be applied as the preferred antibiotics for the treatment of HP in this area due to sensitivity to HP. Metronidazole should not be applied as the first-line antibiotic due to the higher resistance rate.
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