Učestalost Helicobacter pylori infekcije i antibiotska rezistencija kod bolesnika sa akutnim dekompenzacijama jetre

  • Milica Ristić Medicinski fakultet
  • Bojan Korica
  • Klinički asistent dr Vladimir Milivojević
DOI: https://doi.org/10.5937/mp74-39601
Ključne reči: Helicobacter pylori, acute on chronic liver failure, akutna dekompenzacija jetre, rezistencija na antibiotike.

Sažetak


Uvod: Helicobacter pylori (H. pylori) infekcija predstavlja globalni zdravstveni izazov. U svom toku infekcija dovodi do sistemskog porasta proinflamatornih citokina i može da ima ekstragastrične manifestacije, utičući na pogoršanje metaboličkih i kardiovaskularnih bolesti i ugrožavajući normalnu funkciju jetre, posebno kada je prisutna ciroza.

Cilj rada: Cilj ovog istraživanja bio je ispitivanje učestalosti H. pylori infekcije kod bolesnika sa cirozom jetre u stadijumu akutne dekompenzacije (AD) ili ACLF. Takođe, ispitivana je i učestalost antibiotske rezistencije na klaritromicin i fluorohinolone kod H. pylori pozitivnih bolesnika.

Materijal i metode: U našem istraživanju je sprovedena prospektivna studija u koju je uključeno 45 bolesnika sa cirozom jetre, oba pola. Svim učesnicima studije uzeti su uzorci sluzokože želuca, tokom izvođenja gornje endoskopije i slati su na Institut za mikrobiologiju, Medicinskog fakulteta u Beogradu. Za detekciju H. pylori i mutacija odgovornih za rezistenciju na klaritromicin i fluorohinolone korištena je molekularna metoda Polymerase chain reaction (PCR).

Rezultati: Kod 15 dekompenzovanih bolesnika (33,33%) registrovano je prisustvo Helicobacter pylori infekcije, dok je 30 (66,67%) bilo negativno. Kod H. pylori pozitivnih bolesnika PCR detekcijom genotipova odgovornih za antibiotsku rezistenciju detektovana je rezistencija na klaritromicin kod 11 bolesnika (73,33%), dok je na fluorohinolone rezistencija detektovana kod 7 bolesnika (46,66%). Kod 6 bolesnika (40,0%) postojala je udružena rezistencija na klaritromicin i fluorohinolone.

Zaključak: Infekcija Helicobacterom pylori kod cirotičnih bolesnika sa akutnom dekompenzacijom i/ili ACLF-om nema značajan uticaj na težinu kliničkog stanja, povišene parametre laboratorijskih analiza i preživljavanje. Stope rezistencije na fluorohinolone i klaritromicin ili na oba antibiotika su visoke kod ovih bolesnika. Potrebno je da se više jača svijest o racionalnijoj primjeni antibiotika na temelju istraživanja sa većim brojem bolesnika.

Reference


  1. Aranđelović I, Banko A, Ćirković I, Čolović-Čalovski I, Gajić I, Kekić D et al. Helicobacter. In: Savić B, Mitrović S, Jovanović T, editors. Medicinska mikrobiologija. Beograd: Medicinski fakultet Univerziteta u Beogradu, CIBID, 2019. p.277-280.

  2. Diaconu S, Predescu A, Moldoveanu A, Pop CS, Fierbinteanu-Braticevici C. Helicobacter pylori infection: old and new. J Med Life. 2017;10(2):112–117.

  3. Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection‐the Maastricht V/Florence consensus report. Gut. 2017;66(1):6‐30

  4. Nyssen OP, Bordin D, Tepes B, Pérez-Aisa Á, Vaira D, Caldas M et al. European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients. Gut. 2021;70(1):40-54.

  5. Goderska K, Pena SA, Alarcon T. Helicobacter pylori treatment: antibiotics or probiotics. Appl Microbiol Biotechnol. 2018;102(1):1-7.

  6. Pogorzelska J, Łapińska M, Kalinowska A, Łapiński TW, Flisiak R. Helicobacter pylori infection among patients with liver cirrhosis. Eur J Gastroenterol Hepatol. 2017;29(10):1161-1165.

  7. Okushin K, Tsutsumi T, Ikeuchi K, Kado A, Enooku K, Fujinaga H et al. Helicobacter pylori infection and liver diseases: Epidemiology and insights into pathogenesis. World J Gastroenterol. 2018;24(32):3617-3625.

  8. Wei L, Ding HG. Helicobacter pylori infection and peptic ulcer disease in cirrhotic patients: An updated meta-analysis. World J Clin Cases. 2021;9(24):7073-7084.

  9. Traoré O, Diarra AS, Kassogué O, Abu T, Touré S, Maïga A, Diarra M. Gastroduodenal lesions in upper gastrointestinal endoscopy associated with positive Helicobacter pylori histology in cirrhotic patients at Sikasso Hospital: prevalence study. Pan Afr Med J. 2020;37:123.

  10. Zhao B, Sheng Q-J, Qin Y, Wang X-L, Zhao H, Zhao N. Correlations of Helicobacter pylori with liver function, inflammatory factors and serum levels of FoxP3 and RORγt in patients with hepatitis B cirrhosis. Eur Rev Med Pharmacol Sci. 2021;25(1):459-465.

  11. Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet. 2021;398(10308):1359-1376.

  12. Crismale JF, Friedman SL. Acute Liver Injury and Decompensated Cirrhosis. Med Clin North Am. 2020;104(4):647-662.

  13. Zaccherini G, Weiss E, Moreau R. Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment. JHEP Rep. 2020;3(1):100176.

  14. Puentes JC, Rocha H, Nicolau S, Ferrão G. Effectiveness of the MELD/Na Score and the Child–Pugh Score for the Identification of Palliative Care Needs in Patients with Cirrhosis of the Liver. Indian J Palliat Care. 2018;24(4):526–528.

  15. N Ki, Li C, Qian Y, Sun X, Zhan Y, Zeng T et al. MELD Score Reflects the Mood, Sleep, and Daily Living Ability in Liver Transplantation Candidates: A Descriptive Study. Ann Transplant. 2020;25:926857.

  16. Philips CA, Sahney A. Oesophageal and gastric varices: historical aspects, classification and grading: everything in one place. Gastroenterol Rep (Oxf). 2016;4(3):186-195.

  17. Pimentel-Nunes P, Libânio D, Marcos-Pinto R, Areia M, Leja M, Esposito G et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy. 2019;51(4):365-388.

  18. Rabelo-Gonçalves EM, Roesler BM, Zeitune JM. Extragastric manifestations of Helicobacter pylori infection: possible role of bacterium in liver and pancreas diseases. World J Hepatol 2015;7(30):2968–2979.

  19. Kirchner GI, Beil W, Bleck JS, Manns MP, Wagner S. Prevalence of Helicobacter pylori and occurrence of gastroduodenal lesions in patients with liver cirrhosis. Int J Clin Exp Med. 2011;4(1):26-31.

  20. Feng H, Zhou X, Zhang G. Association between cirrhosis and Helicobacter pylori infection: a meta-analysis. Eur J Gastroenterol Hepatol. 2014;26(12):1309-1319.

  21. Tsai CE, Liang CM, Lee CH, Kuo YH, Wu KL, Chiu YC et al. First-line Helicobacter pylori eradication among patients with chronic liver diseases in Taiwan. KJMS. 2016;32:397-402.

  22. Chang SS, Hu HY. Helicobacter pylori: Effect of coexisting diseases and update on treatment regimens. World J Gastrointest Pharmacol Ther. 2015;6(4):127-136.

  23. Huang J, Cui J. Evaluation of Helicobacter pylori Infection in Patients with Chronic Hepatic Disease. Chin Med J (Engl). 2017;130(2):149-154.

  24. Kountouras J, Deretzi G, Zavos C, and Katsinelos P. Helicobacter pylori infection and liver cirrhosis: possible association with hepatic encephalopathy and/or post-hepatic encephalopathy cognitive impairment in patients with portal hypertension. Ann Gastroenterol. 2014;27(3): 285.

  25. Schulz C, Schütte K, Reisener N, Voss J, Malfertheiner P. Prevalence of Helicobacter pylori Infection in Patients with Minimal Hepatic Encephalopathy. Gastrointestin Liver Dis. 2016;25(2):191-195.

  26. Suzuki S, Esaki M, Kusano C, Ikehara H, Gotoda T. Development of Helicobacter pylori treatment: How do we manage antimicrobial resistance? World J Gastroenterol. 2019;25(16):1907-1912.

  27. Hu Y, Zhu Y, Lu NH. Novel and Effective Therapeutic Regimens for Helicobacter pylori in an Era of Increasing Antibiotic Resistance. Front Cell Infect Microbiol. 2017;7:168.

  28. Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions. Ann Gastroenterol. 2018;155(5):1372-1382.

  29. Liu DS, Wang YH, Zhu ZH, Zhang SH, Zhu X, Wan JH et al. Characteristics of Helicobacter pylori antibiotic resistance: data from four different populations. Antimicrob Resist Infect Control. 2019;8:192.

Objavljeno
2024/02/22
Broj časopisa
Vol. 74 Br. 5 (2023): Medicinski podmladak
Rubrika
Originalni naučni članak