INTRODUCTION Antimicrobial resistance among Helicobacter pylori strains has been rising globally, leading to declining eradication rates. We performed a systematic review and meta-analysis of the resistance patterns of H. pylori strains in the United States between 2011 and 2021. METHODS Ovid MEDLINE, Embase, CINAHL, and Cochrane CENTRAL databases were searched for manuscripts and conference abstracts published between 2011 and 2021 reporting H. pylori antibiotic resistance. A mixed-effects model estimated pooled rates of resistance to clarithromycin, amoxicillin, metronidazole, tetracycline, rifabutin, levofloxacin, or a combination of these, with 95% confidence intervals (CIs). RESULTS A total of 19 studies including 2,660 samples, met inclusion criteria. The pooled rate of resistance to metronidazole was 42.1% (95% CI 27.3%-58.6%), levofloxacin 37.6% (95% CI 26.3%-50.4%), clarithromycin 31.5% (95% CI 23.6%-40.6%), amoxicillin 2.6% (95% CI 1.4%-5.0%), tetracycline 0.87% (95% CI 0.2%-3.8%), rifabutin 0.17% (95% CI 0.00%-10.9%), and dual clarithromycin and metronidazole 11.7% (95% CI 0.1%-94.0%). Considerable data heterogeneity was evident for pooled resistance prevalence rates (I 2 > 50%), with the exception of rifabutin resistance. DISCUSSION Metronidazole, levofloxacin, and clarithromycin resistance rates each exceed 30%; thus, choosing an empiric antibiotic regimen without knowledge of the likely pattern of antibiotic resistance is not appropriate. Resistance to tetracycline, rifabutin, and amoxicillin remains low. Given the scarcity of available data with considerable heterogeneity among studies, continued surveillance, ideally with a more systematic approach to data collection, is an increasingly important goal in H. pylori management.

中文翻译：

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2011 年至 2021 年美国幽门螺杆菌抗生素耐药性：系统回顾和荟萃分析。

简介 全球幽门螺杆菌菌株的抗菌药物耐药性一直在上升，导致根除率下降。我们对 2011 年至 2021 年间美国幽门螺杆菌菌株的耐药模式进行了系统回顾和荟萃分析。方法 检索了 Ovid MEDLINE、Embase、CINAHL 和 Cochrane CENTRAL 数据库，查找 2011 年至 2021 年间发表的手稿和会议摘要。 2021 年报告幽门螺杆菌抗生素耐药性。混合效应模型估计了克拉霉素、阿莫西林、甲硝唑、四环素、利福布丁、左氧氟沙星或这些药物组合的耐药率，置信区间 (CI) 为 95%。结果 共有 19 项研究，包括 2,660 个样本，符合纳入标准。合并甲硝唑耐药率为 42.1% (95% CI 27.3%-58.6%)，左氧氟沙星 37.6% (95% CI 26.3%-50.4%)、克拉霉素 31.5% (95% CI 23.6%-40.6%)、阿莫西林 2.6% (95% CI 1.4%-5.0%)、四环素 0.87% (95% CI 0.2) %-3.8%）、利福布丁 0.17%（95% CI 0.00%-10.9%）、克拉霉素和甲硝唑双药 11.7%（95% CI 0.1%-94.0%）。除利福布丁耐药外，汇总耐药率（I 2 > 50%）存在明显的数据异质性。讨论 甲硝唑、左氧氟沙星和克拉霉素的耐药率均超过 30%；因此，在不了解抗生素耐药性可能模式的情况下选择经验性抗生素治疗方案是不合适的。对四环素、利福布丁和阿莫西林的耐药性仍然很低。鉴于可用数据稀缺且研究之间存在相当大的异质性，需要持续监测，