The Analysis Of The Efficacy Of Antibiotic Susceptibility Test As Tailored Rescue Therapy In The Eradication Of Helicobacter Pylori

Objective:To evaluate the efficacy of antibiotic susceptibility test as rescue therapy in the eradication of Helicobacter pylori.According to the result of antibiotic susceptibility test,to formulate tailored therapy for patients who had previous eradication failure.In addition,to set up antibiotic resistance database of Jilin Province and provide guidance to future eradication therapy.Furthermore,to analyze the relevant factors of antibiotic resistance and bacterial amount through endoscopic biopsies.Methods:Retrospective analysis was performed on patients diagnosed as Helicobacter pylori positive by ¹³C-urea breath test after previous treatment failure and received antibiotic susceptibility test from September 2020 to March 2022.Gastric endoscopy was performed for each patient,a total of 4 pieces of gastric mucosa tissues were taken from gastric antrum and gastric body,antibiotic resistance data were obtained,and individual eradication therapy was developed.The ¹³C-urea breath test should be reviewed at least 28 days after discontinuation of the eradication therapy.The eradication therapy was successful if the test result was negative.One more ¹³C-urea breath test should be performed again 6 months later to assess the status of reinfection.Results:1.A total of 141 patients,including 71 males and 70 females,age range（20-73 years old）,65 smokers,62 urban residents and 79 rural residents,were enrolled according to the inclusion and exclusion criteria.There were 60 patients who had been treated once,63patients who had been treated twice,17 patients who had received three times treatment,and1 patient who had been treated four times.Non-atrophic gastritis was found in 96 patients and atrophic gastritis in 45 patients.2.The resistance rate to clarithromycin,metronidazole,levofloxacin,amoxicillin and tetracycline were 73.76%,79.43%,51.06%,19.86%and 0.71%,respectively.All Helicobacter pylori strains were sensitive to furazolidone.The single resistance rate,double resistance rate,triple resistance rate and quadruple resistance rate were 25.53%,20.57%,34.75%and 13.48%,respectively.Only 5.67%of patients were sensitive to six antibiotics.3.The number of previous eradication times was an independent factor affecting the resistance of strains to levofloxacin（P=0.0029）and metronidazole（P=0.0082）.The"goosebump"mucous changes were the independent factor of the obtained bacterial number through endoscopic biopsies（P=0.0071）.4.The cultivation rate of Helicobacter pylori was 89.01%.The overall eradication rate of the rescue therapy guided by antibiotic susceptibility test was 91.49%.The eradication rate of patients who had received one time,two times or at least three times of previous therapy were 96.67%,92.06%and 83.33%.The recurrence rate of Helicobacter pylori infection was 2.33%.A total of 28 patients had at least one adverse event during eradication treatment,and the most frequent adverse event was abdominal distension.Conclusions:1.Antibiotic susceptibility test as a rescue treatment in the eradication of Helicobacter pylori is efficient with low infection recurrence rate and adverse event rate.2.The resistance rate of clarithromycin,metronidazole and levofloxacin were relatively high,while the resistance rate of tetracycline and furazolidone were extremely low,provided guidance for future first line eradication therapy in Changchun,Jilin Province.3.We should decrease the time of eradication therapy to avoid antibiotic resistance.Endoscopists should choose the site of"goosebump"mucosal changes to obtain sufficient Helicobacter pylori to improve the bacterial cultivation rate.