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Abstract：
Background: H. pylori (Helicobacter pylori) infections typically occur in early childhood. Although the prevalence of H. pylori in children is lower than that in adults, the eradication rate of this infection in children is relatively low because of resistance. In this study, we analyzed personalized treatment strategies to achieve treatment goals based on H. pylori resistance characteristics. This retrospective single-center study was conducted between January 2019 and December 2022 and enrolled 1,587 children who presented with upper gastrointestinal symptoms and underwent endoscopy. H. pylori culturing and antimicrobial susceptibility testing were performed. Results: Culture-positive results for H. pylori were obtained in 535 children. The resistance rates to clarithromycin (CLA), metronidazole (MET), and levofloxacin (LEV) were 39.8%, 78.1%, and 20.2%, respectively. None of the isolates were resistant to tetracycline (TET), amoxicillin (AMO), or furazolidone (FZD). Double resistance rates to CLA + MET, CLA + LEV, and MET + LEV were 19.1%, 3.0%, and 5.8%, respectively. Notably, triple-resistant to CLA + MET + LEV was 9.7%. Based on susceptibility tests, individualized triple therapy [proton pump inhibitor (PPI) +AMO + CLA/MET] was selected for 380 children with H. pylori sensitive to MET and/or CLA. In 155 children resistant to CLA and MET, bismuth-based quadruple therapy was recommended; for unable to receive bismuth, concomitant therapy was recommended for 14 children (<8 years of age); triple therapy with TET was recommended for 141 children (>8 years of age), with 43 children (>14 years of age) requiring FZD rather than TET. Conclusion: Resistance to H. pylori in Chinese children was relatively poor. Personalized therapy regimens should be based on susceptibility tests and avoided factors associated with treatment failure.
摘要：
背景：幽门螺杆菌（幽门螺杆菌）感染通常发生在儿童早期。虽然儿童幽门螺杆菌的患病率低于成人，由于耐药性，这种感染在儿童中的根除率相对较低。在这项研究中,我们根据幽门螺杆菌耐药特点分析了个性化治疗策略以达到治疗目标.这项回顾性单中心研究于2019年1月至2022年12月进行，纳入了1,587名出现上消化道症状并接受内窥镜检查的儿童。进行幽门螺杆菌培养和抗菌药物敏感性试验。结果：在535名儿童中获得了幽门螺杆菌的培养阳性结果。对克拉霉素（CLA）的耐药率，甲硝唑（MET），左氧氟沙星(LEV)为39.8%,78.1%,和20.2%，分别。所有分离株对四环素（TET）均无耐药性，阿莫西林（AMO），或呋喃唑酮（FZD）。对CLA+MET的双重耐药率，CLA+LEV,MET+LEV为19.1%，3.0%,和5.8%，分别。值得注意的是,对CLA+MET+LEV的三重抗性为9.7%。根据敏感性试验,对380例幽门螺杆菌对MET和/或CLA敏感的儿童选择个体化三联疗法[质子泵抑制剂(PPI)+AMO+CLA/MET].在155名对CLA和MET有抵抗力的儿童中，推荐以铋为基础的四联疗法；因为无法接受铋，14名儿童（<8岁）推荐合并治疗；141名儿童（>8岁）推荐TET三联疗法，43名儿童（>14岁）需要FZD而不是TET。结论：中国儿童对H.pylori的耐药性相对较差。个性化治疗方案应基于药敏试验并避免与治疗失败相关的因素。
