Quản lý nhiễm Helicobacter pylori ở bệnh nhân nhi khoa tại châu Âu: kết quả từ Đăng ký EuroPedHp

Springer Science and Business Media LLC - 2023
Thu Giang Le Thi1, Katharina Werkstetter1, Kallirroi Kotilea2, Patrick Bontems2, José Cabral3, Mario Pascual4, Michal Kori5,6, Josefa Barrio7, Matjaž Homan8, Nicolas Kalach9, Rosa Lima10, Marta Tavares10, Pedro Urruzuno11, Zrinjka Mišak12, Vaidotas Urbonas13, Sibylle Koletzko1,14, Josef Sýkora7, Erasmo Miele, Andreas Krahl, Martina Klemenak, Alexandra Papadopoulou, Andrea Chiaro, Meltem Uğraş, Jan de Laffolie, Krzysztof Matusiewics, Francesca Rea, Thomas Casswall, Elefthería Roma, Hany Banoub, C Aron, Maria Rosario4, Ana Isabel Lopes
1Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
2Université Libre de Bruxelles, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
3Pediatric Gastroenterology Unit, Dona Estefânia Hospital, University Hospital Centre of Central Lisbon, Lisbon, Portugal
4Pediatrics Department, Gastroenterology Unit, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
5Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
6Pediatric Gastroenterology, Kaplan Medical Centre, Rehovot, Israel
7Department of Paediatrics, Hospital Universitario de Fuenlabrada, Madrid, Spain
8Department of Gastroenterology, Hepatology, and Nutrition, Faculty of Medicine, University Children’s Hospital, University of Ljubljana, Ljubljana, Slovenia
9Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Saint Antoine Paediatric Clinic, Saint Vincent de Paul Hospital, Catholic University, Lille, France
10Division of Paediatrics, Paediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
11Pediatric Gastroenterology Unit, Hospital 12 de Octubre, Madrid, Spain
12Referral Centre for Paediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
13Clinic of Children’s Diseases of Vilnius University Faculty of Medicine, Vilnius, Lithuania
14Department of Paediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland

Tóm tắt

Tóm tắt Mục đích Đăng ký EuroPedHp nhằm theo dõi quản lý tuân thủ hướng dẫn, kháng kháng sinh, và thành công trong việc tiêu diệt của liệu pháp ba kháng sinh trong 2 tuần được điều chỉnh theo độ nhạy kháng sinh (TTT) ở trẻ em mắc nhiễm Helicobacter pylori. Phương pháp Từ năm 2017 đến 2020, 30 trung tâm từ 17 quốc gia châu Âu đã báo cáo dữ liệu dân số, lâm sàng, độ nhạy kháng sinh, điều trị và theo dõi đã được ẩn danh. Hồi quy logistic đa biến đã xác định các yếu tố liên quan đến thất bại trong điều trị. Kết quả Trong số 1605 bệnh nhân, 873 có dữ liệu theo dõi (53,2% nữ, tuổi trung vị 13,0 tuổi, 7,5% có loét), trong đó 741 (85%) chưa điều trị (nhóm A) và 132 (15%) sau khi điều trị thất bại (nhóm B). Kháng metronidazole có mặt ở 21% (A: 17,7%, B: 40,2%), kháng clarithromycin ở 28,8% (A: 25%, B: 51,4%), và cả hai ở 7,1% (A: 3,8%, B: 26,5%). Phần lớn bệnh nhân đã nhận liệu pháp ba kháng sinh điều chỉnh trong 2 tuần, kết hợp ức chế bơm proton (PPI), amoxicillin với clarithromycin (PAC) hoặc metronidazole (PAM). Liều lượng thấp hơn so với liều khuyến cáo cho PPI (A: 49%, B: 41%) và amoxicillin (A: 6%, B: 56%). Ở những bệnh nhân chưa được điều trị, tỷ lệ tiêu diệt đạt 90% (n = 503, 95% CI 87–93%) và 93% ở trẻ em tuân thủ điều trị (n = 447, 95% CI 90–95%). Liệu pháp ba kháng sinh điều chỉnh đã chữa khỏi 59% bệnh nhân sau điều trị thất bại (n = 69, 95% CI 48–71%). Thất bại trong điều trị có liên quan đến PAM ở nhóm kháng clarithromycin đơn lẻ (OR = 2,47, 95% CI 1,10–5,53), với PAC ở nhóm kháng metronidazole đơn lẻ (OR = 3,44, 95% CI 1,47–8,08), và với tuân thủ thấp (OR = 5,89, 95% CI 2,49–13,95). Kết luận Liệu pháp 2 tuần tuân thủ hướng dẫn với PPI, amoxicillin, clarithromycin hoặc metronidazole được điều chỉnh theo độ nhạy kháng sinh đạt tỷ lệ tiêu diệt ban đầu từ ≥ 90%. Tỷ lệ thất bại cao hơn ở các chủng kháng đơn lẻ mặc dù đã điều chỉnh điều trị cho thấy sự thiếu sót trong việc phát hiện kháng kháng sinh do sai sót trong lấy mẫu.

Từ khóa


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