Abstract：Abstract: Objective To analyze the resistance of Helicobacter pylori (H. pylori) in children in Shanghai from 2019 to 2020 to four commonly used antibacterial drugs, and provide a basis for the clinical eradication of H. pylori and rational use of antibacterial drugs. Method From January 2019 to October 2020, 1605 children who came to the Children's Hospital of Fudan University in Shanghai and received gastroscopy and rapid urease test were collected. Gastric mucosal membrane samples were collected for H. pylori isolation, culture and identification. E -test method was used for in vitro susceptibility test. Children were divided into 4 groups according to gender and age [1-3 years old (preschool stage), 4-6 years old (kindergarten stage), 7-12 (primary school stage), 13-17 (middle school stage)]. We analyzed the isolation rate of H. pylori, the overall drug resistance rate to metronidazole, clarithromycin, levofloxacin, and amoxicillin and the double/multi-drug resistance. Results A total of 506 H. pylori strains were isolated from the samples of 1605 children enrolled in this study, the isolation rate was 31.6%. There was no gender difference in H. pylori isolation rate (χ2=0.00, P=0.99) and no age difference (χ2=3.945)(P=0.267). The resistance rates of the isolated H. pylori clinical strains to metronidazole, clarithromycin, levofloxacin, and amoxicillin were 42.3%, 25.1%, 8.1%, and 3%, respectively. H. pylori isolated from male and female children were resistant to 4 drugs There was no statistical difference in the rate (χ2=1.042, p=0.307; χ2=0.04, p=0.841; χ2=0.411, p=0.521; χ2=0.623, p=0.430). There was no significant difference in the resistance rates of H. pylori to amoxicillin, levofloxacin and metronidazole (respectively χ2=2.506, P=0.474; χ2= 1.532, P= 0.675; χ2= 2.854, P= 0.46), The resistance rate of H. pylori to clarithromycin in children aged 13-16 years (31.2%) was significantly higher than that in children aged 1 - 3 years (13.3%) (P=0.040). In addition, the resistance rate of clarithromycin + metronidazole was 18%, which was significantly higher than that of clarithromycin + levofloxacin (5.1%), metronidazole + levofloxacin (4.9%), metronidazole + amoxicillin (1.4%) ), amoxicillin + levofloxacin (0.8%) (χ2=172.706, P<0.01). Multi-drug resistance analysis showed that resistance rate of Levofloxacin + clarithromycin + metronidazole was 3.0% , significantly higher than levofloxacin + amoxicillin + clarithromycin (0.6%), amoxicillin + metronidazole + levofloxacin (0.6%) (Χ2=13.907, P=0.01), the H. pylori isolated from another 2 cases were fully resistant to 4 kinds of antibacterial drugs. Conclusion The H. pylori isolated from children in Shanghai from 2019 to 2020 is highly resistant to metronidazole and clarithromycin, and has a low resistance to amoxicillin and levofloxacin. The dual resistance to metronidazole and clarithromycin is relatively high.
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