Antibiotic Resistance Prevalence and Trends in Patients Infected with Helicobacter pylori in the Period 2013-2020: Results of the European Registry on H. pylori Management (Hp-EuReg)
Luis Bujanda 1 , Olga P Nyssen 2 , Dino Vaira 3 , Ilaria M Saracino 3 , Giulia Fiorini 3 , Frode Lerang 4 , Sotirios Georgopoulos 5 , Bojan Tepes 6 , Frederic Heluwaert 7 , Antonio Gasbarrini 8 , Theodore Rokkas 9 , Dmitry Bordin 10 11 12 , Sinead Smith 13 , Vincent Lamy 14 , María Caldas 2 , Elena Resina 2 , Raquel Muñoz 2 , Ángel Cosme 1 , Ignasi Puig 15 , Francis Megraud 16 , Colm O'Morain 13 , Javier P Gisbert 2 , The Hp-EuReg InvestigatorsAntibiotics (Basel). 2021 Sep 1;10(9):1058.doi: 10.3390/antibiotics10091058.
AbstractBackground: Bacterial antibiotic resistance changes over time depending on multiple factors; therefore, it is essential to monitor the susceptibility trends to reduce the resistance impact on the effectiveness of various treatments. Objective: To conduct a time-trend analysis of Helicobacter pylori resistance to antibiotics in Europe. Methods: The international prospective European Registry on Helicobacter pylori Management (Hp-EuReg) collected data on all infected adult patients diagnosed with culture and antimicrobial susceptibility testing positive results that were registered at AEG-REDCap e-CRF until December 2020. Results: Overall, 41,562 patients were included in the Hp-EuReg. Culture and antimicrobial susceptibility testing were performed on gastric biopsies of 3974 (9.5%) patients, of whom 2852 (7%) were naive cases included for analysis. The number of positive cultures decreased by 35% from the period 2013-2016 to 2017-2020. Concerning naïve patients, no antibiotic resistance was found in 48% of the cases. The most frequent resistances were reported against metronidazole (30%), clarithromycin (25%), and levofloxacin (20%), whereas resistances to tetracycline and amoxicillin were below 1%. Dual and triple resistances were found in 13% and 6% of the cases, respectively. A decrease (p < 0.001) in the metronidazole resistance rate was observed between the 2013-2016 (33%) and 2017-2020 (24%) periods. Conclusion: Culture and antimicrobial susceptibility testing for Helicobacter pylori are scarcely performed (<10%) in Europe. In naïve patients, Helicobacter pylori resistance to clarithromycin remained above 15% throughout the period 2013-2020 and resistance to levofloxacin, as well as dual or triple resistances, were high. A progressive decrease in metronidazole resistance was observed.Keywords: Helicobacter pylori; amoxicillin; antibiotic resistance; clarithromycin; levofloxacin; metronidazole; tetracycline.
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