Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions.
Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions.
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DOI：
10.1053/j.gastro.2018.07.007
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发表时间：
2018-11
期刊：
影响因子：
29.4
通讯作者：
Tacconelli E
中科院分区：
文献类型：
--
作者：
Savoldi A;Carrara E;Graham DY;Conti M;Tacconelli E
2017年，世界卫生组织（WHO）将克拉霉素耐药幽门螺杆菌列为抗生素研发的高度优先事项。然而，目前还没有关于耐药性的全球分布或其临床影响的明确数据。我们进行了一项系统回顾和荟萃分析，以评估幽门螺杆菌对常用抗生素耐药的分布，并衡量抗生素耐药与治疗失败之间的关联。我们检索了文献数据库中评估幽门螺杆菌对克拉霉素、甲硝唑、左氧氟沙星、阿莫西林或四环素耐药率的研究。原发性和继发性耐药的合并估计值和95%置信区间（CI）按WHO区域分组。通过提取耐药和敏感分离株患者的治疗疗效数据，并合并比值比和95% CI，测量抗生素耐药性和治疗失败之间的相关性。我们确定了178项研究，包括来自65个国家的66，142株分离株。在所有WHO地区，克拉霉素、甲硝唑和左氧氟沙星的原发性和继发性耐药率均≥ 15%，但美洲地区（10%; 95% CI，4%-16%）和东南亚地区（10%; 95% CI，5%-16%）的原发性克拉霉素耐药以及欧洲地区（11%; 95% CI，9%-13%）的原发性左氧氟沙星耐药除外。在所有分析中存在相当大的异质性（I2> 75%），这可能是由国家耐药率分组造成的。世卫组织大多数区域都观察到抗生素耐药性增加。克拉霉素耐药与含克拉霉素治疗方案的失败显著相关（比值比，6.97; 95%CI，5.23 - 9.28; P <0.001）。幽门螺杆菌对抗生素的耐药性在世界范围内已达到令人担忧的水平，这对治疗效果产生了很大影响。要求地方监测网络为每个区域选择适当的根除方案。
In 2017, the World Health Organization (WHO) designated clarithromycin-resistant Helicobacter pylori a high priority for antibiotic research and development. However, there are no clear data on the global distribution of resistance or its clinical effects. We performed a systematic review and meta-analysis to assess the distribution of H pylori resistance to commonly used antibiotics and to measure the association between antibiotic resistance and treatment failure. We searched publication databases for studies that assessed rates of H pylori resistance to clarithromycin, metronidazole, levofloxacin, amoxicillin, or tetracycline. Pooled estimates of primary and secondary resistance and 95% confidence intervals (CIs) were grouped by WHO region. The association between antibiotic resistance and treatment failure was measured by extracting data on treatment efficacy in patients with resistant and susceptible isolates and pooling odds ratios with 95% CIs. We identified 178 studies, comprising 66,142 isolates from 65 countries. Primary and secondary resistance rates to clarithromycin, metronidazole, and levofloxacin were ≥15% in all WHO regions, except primary clarithromycin resistance in the Americas (10%; 95% CI, 4%–16%) and South-East Asia region (10%; 95% CI, 5%–16%) and primary levofloxacin resistance in the European region (11%; 95% CI, 9%–13%). There was considerable heterogeneity (I2 > 75%) among all analyses—this might have resulted from the grouping of resistance rates by country. Increasing antibiotic resistance was observed in most WHO regions. Resistance to clarithromycin was significantly associated with failure of clarithromycin-containing regimens (odds ratio, 6.97; 95% CI, 5.23–9.28; P < .001). Resistance of H pylori to antibiotics has reached alarming levels worldwide, which has a great effect on efficacy of treatment. Local surveillance networks are required to select appropriate eradication regimens for each region.
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影响因子：
4.3
作者：
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通讯作者：
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影响因子：
4.4
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Bardhan, KD;Bayerdörffer, E;Zeijlon, L
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Zeijlon, L
DOI：
10.1016/j.diagmicrobio.2010.03.010
发表时间：
2010-08-01
影响因子：
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作者：
Boyanova, Lyudmila;Nikolov, Rossen;Mitov, Ivan
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DOI：
10.1016/j.ijantimicag.2015.08.010
发表时间：
2015-12-01
影响因子：
10.8
作者：
Boyanova, Lyudmila;Evstatiev, Ivailo;Mitov, Ivan
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Mitov, Ivan
DOI：
10.1590/0037-8682-0027-2015
发表时间：
2015-06-01
影响因子：
2
作者：
Caliskan, Reyhan;Tokman, Hrisi Bahar;Kocazeybek, Bekir
通讯作者：
Kocazeybek, Bekir