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Susceptibility-guided bismuth quadruple therapies for resistant Helicobacter pylori infections

Precision Clinical Medicine 2020年第2期3卷 127-135页

作者： Tiankuo Yang Renwei Hu Xiaoqiong Tang Yalin Shen Alfred Tay Xuenan Pi Gang Wang Aleksandra WDebowski Keith AStubbs Mohammed Benghezal barry jmarshall Hong Li Hong Tang West China Marshall Research Center for Infectious Diseases Center of Infectious DiseasesDivision of Infectious DiseasesState Key Laboratory of BiotherapyWest China HospitalSichuan UniversityChengdu 610041China Department of Gastroenterology West China HospitalSichuan UniversityChengdu 610041China Helicobacter pylori Research Laboratory School of Biomedical SciencesMarshall Centre for Infectious Disease Research and TrainingUniversity of Western AustraliaNedlands 6009Australia Precision Medicine Key Laboratory of Sichuan Province&Precision Medicine Center West China HospitalChengdu 610041China School of Molecular Sciences University of Western AustraliaNedlands 6009Australia

Increasing Helicobacter pylori resistance to antibiotics has ledthat molecular testing is appropriate as a sub to adoption of seven different bismuth quadruple therapies(BQT)in China without differentiation of first-line or second-line *** objective of this study was to evaluate the efficacy of susceptibility-guided BQT for patients who had experienced previous treatment failures.A total of 133 patients was included and *** was successfully cultured from 101 patients(75.9%)for subsequent antimicrobial susceptibility testing(AST).Based on the AST results,88 patients completed one of five AST-guided 14-day BQT regimens:esomeprazole and bismuth colloidal pectin,along with either,amoxicillin and clarithromycin(EBAC),amoxicillin and levofloxacin(EBAL),amoxicillin and furazolidone(EBAF),amoxicillin and tetracycline(EBAT),or tetracycline and furazolidone(EBTF).*** eradication rateswere 100%for EBAC(5/5),EBAL(13/13),EBAF(14/14),and EBTF(43/43),but 76.9%for EBAT(10/13).The three patients that failed the EBAT regimenwere all cured after subsequent treatment with the EBTF *** study demonstrates the excellent efficacy of the AST-guided BQT for referred *** patients,and that the current EBAT regimen,used in clinics,needs to be *** addition,57 of the isolates were subjected to whole-genome *** of the sequences revealed that point mutations in 23S rRNA correlated well with the phenotypic clarithromycin resistance with a concordance of 91.2%,while the concordance between phenotypic levofloxacin resistance and gyrA point mutations was 82.3%.This suggests that molecular testing is appropriate as a substitute for AST as a more rapid and cost-effective method for determining clarithromycin and levofloxacin resistance in Chinese patients.

关键词： Helicobacter pylori antibiotic resistance rescue therapy antimicrobial susceptibility testing whole-genome sequencing

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