在初级保健中治疗Helicobacter pylori的失败:一个回顾性队列研究
Gertrude van den Brink1, Lieke M Koggel2, Joris Jh Hendriks2
1Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands g.van_den_brink@lumc.nl.
BJGP open
|March 4, 2024
概括
在Helicobacter pylori (HP) 感染中抗生素耐药性正在上升,近10%的初级保健患者需要第二次治疗. 这种趋势,标志着每年治疗失败率的增加,需要对当前的根除指南进行审查.
科学领域:
- 传染性疾病 传染性疾病
- 微生物学 微生物学
- 公共卫生 公共卫生
背景情况:
- 由于抗生素耐药性增加,Helicobacter pylori (HP) 根除治疗的疗效在全球范围内正在下降.
- 这在有效管理HP感染方面构成了重大挑战.
研究的目的:
- 在初级保健机构内调查HP中抗菌素耐药性的流行率和趋势.
- 评估初始HP根除疗法的成功率,并确定与治疗失败相关的因素.
主要方法:
- 一项回顾性队列研究使用了2010年至2020年期间来自荷兰80家普通医院的现实世界医疗保健数据进行.
- 确定了患有胃部症状或使用酸抑制的患者. 抗微生物耐药性是由需要在12个月内进行第二次根除治疗来定义的.
主要成果:
- 在138,455名确诊患者中,5224名 (4%) 接受了HP根除治疗. 416名 (8%) 患者需要进行第二次治疗.
- 治疗失败与含有澄胺和/或甲尼达的第一线疗法有关. 在需要第二次治疗的患者中,观察到每年增加0.8%.
- 在治疗后一年,治疗失败的患者 (85%) 的酸抑制使用明显高于成功根除 (48%) 的患者.
结论:
- 在初级保健中,近十分之一的HP感染在单一治疗过程中没有成功根除,其中包括克拉里胺和/或甲尼达.
- 虽然治疗失败率低于二级护理,但观察到的增加趋势令人担忧.
- 目前针对HP根除的指导方针可能需要修订,以解决初级保健中抗菌素耐药性增加的问题.
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