| PurposeTo investigate the distribution of the Helicobacter pylori(H. pylori) infection and examine the susceptibility that commonly used on antibiotics of H. pylori clinical isolates in vitro, analysis possible factors with the use of antibiotics and survey of physicians focusing on the views about treatments.Methods1.The research object was selected in the Second Hospital Affiliated to Chongqing Medical University, which was divided into groups based on gender and age.H. pylori infection was detected by 13C-ura breath test(13C-UBT).2. Patients attend scheduled visits provided gastric biopsy samples on a volunteer basis. H. pylori isolates was cultured from corpus and antrum biopsies, and antimicrobial susceptibility testing(on metronidazole, clarithromycin, amoxicillin, levofloxacin, tetracycline and furazolidone) was conducted.3. The DDDs value was a measure of the frequency of drug use.4. Some questions according to the Treatment points in the Maastricht-IV consensus were adopted to test. Between March and August, 2014, physicians with various properties from randomized Hospital in Chongqing were surveyed.5. The treatments of clinicians were been observed and outcomes followed.Results1. H. pylori-positive rate in 19200 participants was 37.1%,and there was significant difference in the positive rate between men and women.The positive rate of H. pylori also had positive relation with age.2. A total of 79 H. pylori strains were isolated. Of these strains, 97.5%(77/79) were resistant to metronidazole, 35.4%(28/79) were resistant to clarithromycin, and 43.0%(34/79) were resistant to levofloxacin. We detected no amoxicillin, furazolidone or tetracycline resistance in our study. The resistance rates of double and triple were 35.4% and 21.5%, respectively.3. The top three uses of antibiotics in 2014 in the Second Hospital Affiliated to Chongqing Medical University are amoxicillin, clarithromycin and metronidazole.4. A total of 140 physicians answered the questionnaire voluntarily. Forty percent engaged in the gastroenterology. In therapy, a quadruple therapy consists of esomeprazole, bismuth, amoxicillin and clarithromycin(CA) or clarithromycin and nitroimidazole(CN) is the most commonly use. The grade of hospital and specialty of physicians in therapy was correlated with choices of indications(53.3 vs. 21.1%; OR:0.233; 95% CI: 0.109-0.502;P=0.000)(Gastroenterology 50.9 vs. 28.2%;OR:2.636;95% CI:1.297-5.355;P=0.007), the regimen and cutcome of treatment(70.5 vs. 29.5%;OR:0.231;95% CI: 0.109-0.490;P=0.000)(Gastroenterology 87.3 vs. 32.9%;OR:13.959;95% CI:5.603-34.780;P=0.000). But not the choice of rescue therapy(9.5 vs. 6.7%; OR:1.465; 95% CI: 0.377-5.695;P=0.580)(Gastroenterology 9.1 vs. 8.2%;OR:1.114;95% CI:0.335-3.704;P=1.000) and treatment course.5. In clinical practice, a quadruple therapy consists of esomeprazole, bismuth, amoxicillin and furazolidone(PBAF) is the most commonly use. Quadruple regimen is better than triple regimen(82.1 vs. 38.9%; OR: 7.210;95% CI: 2.441-21.298; P=0.000)。There is no difference of H. pylori eradication rate between regimens with ten days or forty days(75.0 vs. 79.2%; OR: 0.786;95% CI: 0.252-2.451; P=0.677).Conclusion1. H. pylori infection rate was below the national average in Chongqing,and infection rate is related with gender and age. Residents over the age of 50 are focus of the crowd.2. The resistance in Chongqing, especially to metronidazole, clarithromycin and levofloxacin, was consistent with the other areas.3. The management of H. pylori was found to be inadequate for physicians in Chongqing. Continuing medical education on the treatment of H. pylori is urgently needed, especially for non-digestive and primary care physicians.4. Based on the high resistance, the ten or forty-day regimen with PPI, bismuth, amoxicillin and furazolidone is recommended. |
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