Đề kháng kháng sinh nguyên phát của vi khuẩn Helicobacter pylori ở bệnh nhân viêm loét dạ dày tá tràng

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Tác giả: Hồng Thanh Nguyễn, Thị Khánh Tường Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.142

Bộ sưu tập: Metadata

ID: 339399

Thêm vào giỏ Liên kết toàn văn

- Đặt vấn đề: Đề kháng kháng sinh là nguyên nhân chính dẫn đến thất bại điều trị tiệt trừ Helicobacter pylori. Việc cập nhật tình hình đề kháng kháng sinh của Helicobacter pylori trong từng khu vực có ý nghĩa quan trọng trong việc khuyến cáo lựa chọn phác đồ điều trị phù hợp với quần thể và tối ưu hóa hiệu quả điều trị tiệt trừ Helicobacter pylori cho từng khu vực, quốc gia.- Mục tiêu: Xác định tỷ lệ đề kháng nguyên phát của vi khuẩn Helicobacter pylori với kháng sinh Amoxicillin, Clarithromycin, Levofloxacin, Metronidazole và Tetracycline.- Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang thực hiện trên 216 bệnh nhân viêm loét dạ dày tá tràng, được thực hiện nội soi và nuôi cấy kháng sinh đồ Epsilometer test tại bệnh viện Quốc Tế Mỹ từ tháng 10/2019 - 9/2022- Kết quả: Tỷ lệ đề kháng nguyên phát với kháng sinh Clarithromycin chiếm tỷ lệ cao nhất lên đến 96,30%, tỷ lệ đề kháng với Levofloxacin, Metronidazole, Amoxicillin lần lượt chiếm 58,8%, 8,80% và 2,78%. Trong nghiên cứu không thấy trường hợp nào kháng nguyên phát với Tetracycline, tỷ lệ 0%. Tỷ lệ kháng từng loại kháng sinh trong nhóm nam và nữ không có sự khác biệt có ý nghĩa thông kê p >
0,05. Tỷ lệ kháng kép với 02 loại kháng sinh rất cao, có 161/216 trường hợp chiếm 74,54%, trong đó tỷ lệ kháng với CLA+ LEV chiếm tỷ lệ cao nhất là 124 trường hợp chiếm 57,41%. Tỷ lệ chủng Helicobacter pylori kháng CLA+MET, MET+LEV, CLA+AMX, AMX+LEV, AMX+MET chiếm tỷ lệ lần lượt là 7,41%, 3,7%, 2,78%, 1,39% và 0,46%. Có 11 trường hợp chủng H.pylori đa kháng 3 loại kháng sinh chiếm tỷ lệ 5,09%, không có trường hợp nào kháng từ 04 loại kháng sinh trở lên. Chỉ có 1,39% còn nhạy với cả 5 loại kháng sinh trong các phác đồ tiệt trừ.- Kết luận: Tỷ lệ đề kháng với Clarithromycin rất cao cho thấy phác đồ bộ ba tiêu chuẩn hầu như không còn hiệu quả và không nên được sử dụng trong lâm sàng. Phác đồ có Levofloxacin nên phối hợp thêm Bismuth để nâng cao hiệu quả điều trị. Tỷ lệ đề kháng với Amoxicillin, Tetracycline và Metronidazole thấp, nên phác đồ 4 thuốc có Bismuth hoặc phác đồ phối hợp 3 thuốc trên với nhau sẽ có thể hiệu quả trong điều trị tiệt trừ Helicobacter pylori. Abstract- Background: Antibiotic resistance is the main cause of failure of Helicobacter pylori eradication. Updating the antibiotic resistance situation of Helicobacter pylori in each region is important in recommending the selection of regimens. appropriate treatment plan for the population and optimize the effectiveness of Helicobacter pylori eradication treatment for each region and country.- Objective: To detemine the rate of primary antibiotics resistance of Helicobacter pylori strains to Amoxicillin, Clarithromycin, Levofloxacin, Metronidazole and Tetracycline.- Method: A cross - sectional descriptive study performed on 216 patients with peptic ulcer disease, performed endoscopy and antibiotic culture by Epsilometer testat the American International Hospital from October 2019 to September 2022.- Results: The rate of primary resistance to the antibiotic Clarithromycin was the highest 96.30%, the rate of resistance to Levofloxacin, Metronidazole, Amoxicillin were 58.8%, 8.80% and 2.78% respectively. In the study, there was no case of primary antibiotic resistance with Tetracycline, rate 0%. There was no statistically significant difference in the rate of resistance to each antibiotic in the male and female groups, p >
0.05. The rate of dual resistance to 02 antibiotics was very high, with 161/216 cases, rate 74.54% and the highest rate of resistance to CLA+ LEV was 124 cases, rate 57.41%. The rate of H.pylori strains resistant to CLA+MET, MET+LEV, CLA+AMX, AMX+LEV, AMX+METswere 7.41%, 3.7%, 2.78%, 1.39%, 0.46% respectively. There were 11 cases of H.pylori strains that were resistant to 3 types of antibiotics, rate 5.09%, there were no cases that were resistant to 4 or more antibiotics. Only 1.39% remained sensitive to all 5 antibiotics in eradication regimens.- Conclusion: The very high rate of resistance to Clarithromycin suggests that the standard triple regimen is almost no effective and should not be used in clinical practice. The regimen with Levofloxacin should be combined with Bismuth to improve the effectiveness of treatment. The rate of resistance to Amoxicillin, Tetracycline and Metronidazole was low, so Bismuth quadruple or a combination of these three drugs may be very effective in the treatment of Helicobacter pylori eradication. DOI: 10.59715/pntjmp.1.4.16

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