| Abstract | Helicobacter pylori (H. pylori) infekcija je jedna od najčešćih infekcija u čovjeka. Zbog sve većeg udjela sojeva H. pylori rezistentnih na antimikrobne lijekove i ograničenog uspjeha empirijskih antimikrobnih eradikacijskih terapija, potrebno je poznavati profil antimikrobne osjetljivosti lokalnih sojeva kako bi se optimiziralo liječenje. Primarni cilj ovog istraživanja je utvrđivanje primarne i sekundarne osjetljivosti sojeva H. pylori u promatranih bolesnika na amoksicilin, metronidazol, klaritromicin, tetraciklin i levofloksacin. Sekundarni ciljevi su utvrđivanje kretanja stope rezistencije H. pylori na promatrane antibiotike u odnosu na broj prethodno provedenih kombiniranih helikocidnih terapija i analiza odnosa osnovnih demografskih, epidemioloških i kliničkih obilježja te prisutnosti H. pylori infekcije. Ova retrospektivna deskriptivna studija je provođena u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ u razdoblju od 04/2019. do 11/2021. Uključeni su odrasli bolesnici kojima je u bioptatu želučane sluznice nakon ezofagogastroduodenoskopije (EGDS), metodom mikroskopiranja, ureaza testa, ili kultivacijom dokazan H. pylori. Osjetljivost sojeva je testirana gradijent testom. Demografski i epidemiološki podatci prikupljeni su od pacijenata putem upitnika prije uzimanja uzoraka želučane sluznice. Učinjeno je 668 EGDS, prosječna dob pacijenata je bila 50 godina (medijan: 51 godina) te su među njima prevladavale žene (63%). Od 341 H. pylori pozitivnih pacijenta kultivacija je uspjela u njih 124, od toga je bilo 98 (79,03%) primarnih i 26 (20,97%) sekundarnih izolata. Ukupna rezistencija na klaritromicin je bila 16,1% (primarna 13,3%), na metronidazol 47,6% (primarna 40,8%) i na levofloksacin 4,0% (primarna 4,1%), a nije nađena rezistencija na amoksicilin ni tetraciklin. Zabilježena su 4 slučaja dvojne rezistencije na metronidazol i levofloksacin (3,3%) i 14 slučajeva dvojne rezistencije na metronidazol i klaritromicin (11,3%). Zabilježeno je značajno povećanje udjela sojeva rezistentnih na klaritromicin i metronidazol s povećanjem broja prethodno provedenih helikocidnih terapija (redom p= 0,034, p= 0,009). Možemo zaključiti da u promatranoj populaciji prije provođenja prve empirijske helikocidne terapije nije potrebno testiranje osjetljivosti sojeva H. pylori na klaritromicin, a zbog utvrđene visoke primarne rezistencije na metronidazol preporučljivo je duže korištenje metronidazola u većim dozama u prvoj kuri helikocidne terapije ili dodavanje preparata bizmuta. |
| Abstract (english) | Helicobacter pylori (H. pylori) infection is one of the most common infections in humans. Due to the increasing proportion of H. pylori strains resistant to antimicrobial drugs and the limited success of empirical antimicrobial eradication therapies, it is necessary to know the antimicrobial susceptibility profile of local strains in order to optimize treatment. The primary objective of this study was to determine the primary and secondary susceptibility of H. pylori strains in the observed patients to amoxicillin, metronidazole, clarithromycin, tetracycline, and levofloxacin. Secondary objectives are to determine the rate of resistance of H. pylori to the observed antibiotics in relation to the number of previously conducted combination helicocidal therapies and to analyze the relationship between basic demographic, epidemiological, and clinical characteristics and the presence of H. pylori infection. This retrospective descriptive study was conducted at the Clinic for Infectious Diseases "Dr. Fran Mihaljević ”in the period from 04/2019 to 11/2021. Adult patients who underwent gastric mucosal biopsy after esophagogastroduodenoscopy (EGDS), microscopy, urease test, or culturing of H. pylori were included. The susceptibility of the strains was tested by a gradient test. Demographic and epidemiological data were collected from patients through a questionnaire before gastric mucosal sampling. 668 EGDS were performed, the average age of patients was 50 years (median: 51 years) and women predominated among them (63%). In 341 H. pylori-positive patients, cultivation was successful in 124, of which 98 (79,03%) were primary and 26 (20,97%) secondary isolates. Total resistance to clarithromycin was 16.1% (primary 13,3%), to metronidazole 47,6% (primary 40,8%), to levofloxacin 4,0% (primary 4,1%), and no resistance was found of amoxicillin and tetracycline. There were 4 cases of dual resistance to metronidazole and levofloxacin (3,3%) and 14 cases of dual resistance to metronidazole and clarithromycin (11,3%). There was a significant increase in the proportion of strains resistant to clarithromycin and metronidazole with an increase in the number of previously conducted helicocidal therapies (p = 0,034, p = 0,009 respectively). We can conclude that in the observed population, susceptibility testing of H. pylori strains to clarithromycin is not required before the first empirical helicocidal therapy and due to the established high primary resistance to metronidazole, it is recommended to use metronidazole in higher doses for a longer time in the first course of helicocidal therapy or to add bismuth preparations. |
