Антибиотикорезистентность Helicobacter pylori в европейской части Российской Федерации: первые результаты
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Maev I.V., Andreev D.N., Govorun V.M., et al. Antibiotic resistance of Helicobacter pylori in the European part of the Russian Federation: first results. Therapeutic Archive. 2020; 92 (8): 24–28. DOI: 10.26442/00403660.2020.08.000761
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Материалы и методы. В рамках клинико-лабораторного исследования в период с 2015 по 2018 г. проанализировано 27 гастробиопсийных образцов, полученных от H. pylori-инфицированных пациентов. Верификация инфицированности H. pylori проводилась с помощью быстрого уреазного теста, а также 13С-уреазного дыхательного теста. Значения минимальной подавляющей концентрации антибиотиков определяли диффузионным методом с применением полосок Е-тест (BioMerieux, Франция) согласно рекомендациям фирмы-производителя. Чувствительность изолятов определяли к 6 антибактериальным препаратам (амоксициллин, кларитромицин, метронидазол, левофлоксацин, тетрациклин, рифампицин).
Результаты. Согласно полученным данным, резистентность к амоксициллину составила 0%, кларитромицину – 11,1%, метронидазолу – 59,3%, левофлоксацину – 3,7%, тетрациклину – 0%, а рифампицину – 14,8%. Двойная резистентность к кларитромицину и метронидазолу зарегистрирована у 2 (7,4%) изолятов.
Заключение. Первые результаты оценки антибиотикорезистентности H. pylori в европейской части РФ свидетельствуют о низкой резистентности микроорганизма к кларитромицину и достаточно высокой к метронидазолу.
Ключевые слова: Helicobacter pylori, эрадикационная терапия, резистентность, чувствительность, антибактериальные препараты, амоксициллин, кларитромицин, метронидазол, левофлоксацин.
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Aim. Determine the primary antibiotic resistance of Helicobacter pylori (H. pylori) strains isolated from patients living in the European part of the Russian Federation.
Materials and methods. As part of a clinical laboratory study, from 2015 to 2018, 27 gastrobiopsy samples obtained from H. pylori-infected patients were analyzed. H. pylori infection was verified using a rapid urease test or a 13C-urea breath test. The values of the minimum inhibitory concentration (MIC) of antibiotics were determined by the diffusion method using E-test strips (BioMerieux, France) according to the recommendations of the manufacturer. The sensitivity of the isolates was determined for 6 antibacterial drugs (amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, rifampicin).
Results. According to the data obtained, resistance to amoxicillin was 0%, clarithromycin – 11.1%, metronidazole – 59.3%, levofloxacin – 3.7%, tetracycline – 0%, and rifampicin – 14.8%. Dual resistance to clarithromycin and metronidazole was recorded in two isolates (7.4%).
Conclusion. Thus, the first results of the evaluation of H. pylori antibiotic resistance in the European part of the Russian Federation indicate a low resistance of the microorganism to clarithromycin and quite high to metronidazole.
Keywords: Helicobacter pylori, eradication therapy, resistance, sensitivity, antibacterial drugs, amoxicillin, clarithromycin, metronidazole, levofloxacin.
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2. Suzuki H, Warren R, Marshall B. Helicobacter Pylori; Springer: Tokyo, Japan, 2016.
3. Ivashkin VT, Mayev IV, Lapina TL, et al. Diagnostics and treatment of Helicobacter pylori infection in adults: Clinical guidelines of the Russian gastroenterological association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(1):55-70. (In Russ.) doi: 10.22416/1382-4376-2018-28-1-55-70
4. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus. Report. Gut. 2017;66(1):6-30. doi: 10.1136/gutjnl-2016-312288
5. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017;112(2):212-39. doi: 10.1038/ajg.2016.563
6. Sugano K, Tack J, Kuipers EJ, et al.; faculty members of Kyoto Global Consensus Conference. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353-67. doi: 10.1136/gutjnl-2015-309252
7. Lee YC, Chen TH, Chiu HM, et al. The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention. Gut. 2013;62:676-82. doi: 10.1136/gutjnl-2012-302240
8. Malfertheiner P, Link A, Selgrad M. Helicobacter pylori: perspectives and time trends. Nat Rev Gastroenterol Hepatol. 2014;11(10):628-38. doi: 10.1038/nrgastro.2014.99
9. Iwańczak F, Iwańczak B. Treatment of Helicobacter pylori infection in the aspect of increasing antibiotic resistance. Adv Clin Exp Med. 2012;21(5):671-80.
10. Vianna JS, Ramis IB, Ramos DF, et al. Drug resistance in Helicobacter pylori. Arq Gastroenterol. 2016;53(4):215-23. doi: 10.1590/S0004-28032016000400002
11. Maev IV, Andreev DN. Molecular genetic predictors of resistance to anti-Helicobacter pylori therapy. Therapeutic Archive. 2017;89(8):5-12 (In Russ.) doi: 10.17116/
terarkh20178985-12
12. Savoldi A, Carrara E, Graham DY, et al. Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions. Gastroenterology. 2018;155(5):1372-82.e17. doi: 10.1053/j.gastro.2018.07.007
13. Maev IV, Kucheryavyi Yu.A, Andreev DN, Barkalova EV. Eradication therapy for Helicobacter pylori infection: review of world trends. Therapeutic Archive. 2014;86(3):94-9 (In Russ.).
14. Graham DY, Lee YC, Wu MS. Rational Helicobacter pylori therapy: evidence-based medicine rather than medicine-based evidence. Clin Gastroenterol Hepatol. 2014;12:177-86. doi: 10.1016/j.cgh.2013.05.028
15. Perez Aldana L, Kato M, Nakagawa S, et al. The relationship between consumption of antimicrobial agents and the prevalence of primary Helicobacter pylori resistance. Helicobacter. 2002;7:306-9.
16. Megraud F, Coenen S, Versporten A, et al.; Study Group participants. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut. 2013;62(1):34-42. doi: 10.1136/gutjnl-2012-302254
17. Boyanova L, Ilieva J, Gergova G, et al. Numerous risk factors for Helicobacter pylori antibiotic resistance revealed by extended anamnesis: a Bulgarian study. J Med Microbiol. 2012;61(Pt 1):85-93. doi: 10.1099/jmm.0.035568-0
18. Lim SG, Park RW, Shin SJ, et al. The relationship between the failure to eradicate Helicobacter pylori and previous antibiotics use. Dig Liver Dis. 2016;48(4):385-90. doi: 10.1016/j.dld.2015.12.001
19. Andreev DN, Maev IV, Kucheryavyi YA, et al. The efficiency and safety of anti-Helicobacter pylori therapy in patients with concomitant chronic hepatitis C. Therapeutic Archive. 2016;88(4):75-81 (In Russ.) doi: 10.17116/terarkh201688475-81
20. McNulty CA, Lasseter G, Shaw I, et al. Is Helicobacter pylori antibiotic resistance surveillance needed and how can it be delivered? Aliment Pharmacol Ther. 2012;35(10):1221-30. doi: 10.1111/j.1365-2036.2012.05083.x
21. Bordin DS, Embutnieks YV, Vologzhanina LG, et al. European Registry on the management of Helicobacter pylori infection (Hp-EuReg): analysis of 2360 patients receiving first-line therapy in Russia. Therapeutic Archive. 2018;90(2):35-42 (In Russ.). doi: 10.26442/terarkh201890235-42
22. Samsonov AA, Grechushnikov VB, Andreev DN, et al. Pharmacoeconomic evaluation of treatment in patients with Helicobacter pylori-associated diseases. Therapeutic Archive. 2014;86(8):56-61 (In Russ.).
23. Andreev DN, Dicheva DT, Maev IV. Possibilities for optimization of eradication therapy for Helicobacter pylori infection in modern clinical practice. Therapeutic Archive. 2017;89(2):84-90 (In Russ.). doi: 10.17116/terarkh201789284-90
24. Ko SW, Kim YJ, Chung WC, Lee SJ. Bismuth supplements as the first-line regimen for Helicobacter pylori eradication therapy: Systemic review and meta-analysis. Helicobacter. 2019;24(2):e12565. doi: 10.1111/hel.12565
25. Andreev DN, Maev IV, Dicheva DT. Efficiency of the Inclusion of Rebamipide in the Eradication Therapy for Helicobacter pylori Infection: Meta-Analysis of Randomized Controlled Studies. J Clin Med. 2019;8(9). pii: E1498. doi: 10.3390/jcm8091498
1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия;
2 ФГБУ «Федеральный научно-клинический центр физико-химической медицины» ФМБА России, Москва, Россия;
3 ГБУЗ «Городская клиническая больница №4» Департамента здравоохранения г. Москвы, Москва, Россия;
4 ООО «Медицинский центр диагностики и профилактики», Ярославль, Россия;
5 ООО Лаборатория «Литех», Москва, Россия;
6 ООО НПФ «Литех», Москва, Россия;
7 ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава России, Ярославль, Россия
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I.V. Maev1, D.N. Andreev1, V.M. Govorun2, E.N. Ilina2, Yu.A. Kucheryavyy1, T.S. Oganesian3, E.V. Melnikova4, O.V. Zayratyants1, T.V. Parfenova5, L.V. Dzhedzheia5, N.V. Kirillova6, E.A. Maevskaya1, A.K. Fomenko1, E.G. Lobanova1, A.V. Zaborovskii1, K.A. Kriukov7
1 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia;
2 Federal Research And Clinical Center of Physical-Chemical Medicine Federal Medical Biological Agency, Moscow, Russia;
3 City Clinical Hospital №4, Moscow, Russia;
4 Medical Center for Diagnostics and Prevention, Yaroslavl, Russia;
5 Laboratory "Litekh", Moscow, Russia;
6 "Litekh", Moscow, Russia;
7 Yaroslavl State Medical University, Yaroslavl, Russia