Relation of H.pylori eradication rate and antibioticresistance: A twelve-year retrospective study in Southern Taiwan

• Main Authors: Chih-Yin Cheng, 鄭智尹
• Other Authors: Deng-Chyang Wu
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/43666172161830976640

碩士 === 高雄醫學大學 === 醫學研究所碩士班 === 103 === Background: PPI-based triple therapy is the gold standard for Helicobacter pylori (H. pylori) first-line eradication. However,successful eradication is falling due to increasing antibioticsresistance worldwide. Therefore, many people have been referred for the secondary and third-line salvage therapies or newly designed first-line therapies to improve eradication success rate. Aim to this study, we attempt to analyze the trend of antibiotics resistance of H. pylori, impact of antibiotics resistance on the eradication rate from first-line to third-line treatment, independence factors for the resistance in single medical center in southern Taiwan. Materials and Methods: We retrospectively investigated the chart records of patients in Kaohsiung Medical University from September 2003 to July 2014 and separated the participants in four different groups including first-line treatment without culture and first-line to third-line treatment with culture. The inclusion criteria included those who had received esophagogastroduodenoscopy (EGD) examination and 13C-urea breathe test (UBT) to confirm the status of H. pylori. Then tissue sample biopsied by EGD were cultured and antibiotics resistance was detected by E-test if culture is positive. Five drugs were studied, including Metronidazole, Clarithromycin, Tetracycline, Levofloxacin and Amoxicillin. All people had received any line treatment were confirmed if eradication is successful under follow EGD and UBT. In addition, we also observed the impact of antibiotics resistance on the eradication rate by statistics method. We also survey independent risk factors for antibiotics resistance in different line treatment with lone antibiotics. Results: 1227 case had first-line treatment without H.pylori culture was recruited and eradication success rate from 86% to 75 %. 154 cases had first-line treatment with H. pylori culture and eradication success rate reduced from 2010~2011 96.1% to 2012~2013 95.1 % and different antibiotics resistance includes Metronidazole: 28.8% to 34.8%, Clarithromycin: 5.8% to 0%, Tetracycline: 0% to 4.3 %, Levofloxacin: 13.5% to 30.4% and Amoxicillin: 0% to 4.3%. 237 cases had second-line treatment with H. pylori culture and eradication success rate reduced from 2009~2011 79.7% to 2012~2013 60 % and different antibiotics resistance includes Metronidazole: 47.8% to 53.3%, Clarithromycin: 58% to 66.7%, Tetracycline: 0% to 6.7 %,Levofloxacin: 26.1% to 40% and Amoxicillin: 0% to 0%. 39 cases had third-line treatment with H. pylori culture and eradication success rate reduced from 2005~2008 68% to 2009~2012 68.4 % and different antibiotics resistance includes Metronidazole: 76% to 64.3%, Clarithromycin: 64.5% to 32.5%, Tetracycline: 0% to 7.1%, Levofloxacin: 50% to 50% and Amoxicillin: 0% to 0%. We also found antibiotics resistance effects eradication rate especially increasing Clarithromycin resistance reduces eradication rate of first-line and third treatment, Metronidazole resistance reduces it of first-line and second-line treatment and Levofloxacin reduced it of second-line and third-line treatment. Sex has been a risk factor to Metronidazole resistance and no other factors are found to affect other antibiotics resistance. Conclusion: In our retrospective study, we could find emerging resistance to antibiotics rate has affected the eradication success rate in 12 years. Resistance to Metronidazole and Clarithromycin increased in first-line and second-line treatment, although decreased in third-line treatment, remained as least 30%. Levofloxacin increased dominantly in first-line and second-line treatment and maintains as high as 50 % in third-line treatment. Resistance to Tetracycline and Amoxicillin resistance was nearly 0 % across the board indifferent line treatment. Specific antibiotics resistance influence alternative line treatment and no obvious risk factor was survey except forsex for Metronidazole.