Trend analysis of Helicobacter pylori resistance to clarithromycin and levofloxacin in Wenling area from 2014 to 2018

ObjectiveTo understand the trend of Helicobacter pylori （Hp） resistance to clarithromycin and levofloxacin and to provide guidance for Hp eradication therapy.

MethodsFrom January 2014 to December 2018， a total of 66 515 patients with gastrointestinal symptoms were enrolled in the First People's Hospital of Wenling. The patients were divided into the following groups： childhood （0 to 6 years old）； juvenile （7 to 17 years old）； youth （18 to 40 years old），middle age （41 to 65 years old），and old age （≥66 years old）. All patients received gastroscopy， gastric mucosal biopsy， Hp culture and drug sensitivity test of clarithromycin and levofloxacin.

ResultsThe Hp positive rate showed a significant downward trend in 2016， 2017 and 2018 （χ²=14.317， 47.079， 88.054，all P<0.05）. The average resistance rate of Hpto clarithromycin from 2014 to 2018 was 22.72% （4 732/20 831） showing an increasing trend， but the increase was slower after 2017. The average resistance rate to levofloxacin was 30.55% （6 364/20 831）， and the overall trend showed a sharp rise from 2015 to 2017 （χ²=38.383， 49.569， both P<0.05）， and a significant decline was detected after 2017 （χ²=18.841， P<0.05）. The resistance rate of Hp to levofloxacin in patients increased with age. The clarithromycin resistance rate first decreased and then increased with age， and the resistance rate in old age （32.52%， 763/2 346） was higher than that in youth （22.09%， 1 086/4 916） and middle age patients （21.21%， 2 854/13 458）， and the differences were significant （χ²=991.071， 144.968， both P<0.05）. The resistance rate of Hp rose from 12.73% （14/110） in juvenile to 43.31% （1 016/2 346） in old age （χ²=228.867， P<0.05）.

ConclusionIn recent years， the positive rate of Hpinfection in Wenling area has a decreasing trend. Although the resistance rate of Hp to clarithromycin and levofloxacin has been rising slowly or decreasing， it is still at a high level. In the selection of Hp eradication program， the differences between patients in different age groups should be considered with particular attention on the minors.