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THE PATTERN OF HELICOBACTER PYLORI PCR-ASSESSED ANTIBIOTIC RESISTANCE: EXPERIENCE FROM THE EUROPEAN REGISTRY ON HELICOBACTER PYLORI MANAGEMENT (HP-EUREG)

Vladimir Milivojevic 1, Dusan Kekic 2, Tomica Milosavljevic 3, Ivana Babic 4, Giuseppe Losurdo 5, Javier Tejedor-Tejada 6, Tamara Matysiak-Budnik 7, Liudmila Vologzhanina 8, Tatiana Ilchishina 9, Ioannis Linas 10, Irina Voynovan 11, Luis Ricardo Rodrigo Sáez 12, Natalia Bakulina 13, Igor Bakulin 14, Marco Romano 15, Matteo Pavoni 16, Blas José Gómez-Rodríguez 17, György Miklós Buzás 18, Melanija Ražov-Radas 19, Antonietta Gerarda Gravina 20, Natalia Vladimirovna Baryshnikova 21, Giulia Fiorini 22, Marko Nikolic 23, Liya Belousova 24, Katarina Jankovic 25, Kateryna Priadko 26, Ismar Hasukic 27, Alfredo Di Leo 28, Amila Osmanovic 29, Claudia Isabel Paéz Cumpa 30, Berardino Vaira 31, Anastasiya Sushilova 32, Selma Hodzic 29, Antonia Perelló Juan 33, Antonio Gasbarrini 34, Luis Hernández Villalba 35, Dmitry S. Bordin 11, Michael Doulberis 36, Antonio Mestrovic 37, Veronika Papp 38, Anna Cano Català 39, Pablo Parra 40, Leticia Moreira Ruiz 41, Olga P. Nyssen 40, Francis Mégraud 42, Colm O'Morain 43, Javier P. Gisbert 40

Affiliations

1 University Clinical Centre of Serbia, Belgrade University, Belgrade, Serbia

2 Medical Faculty University of Belgrade, Institute of Microbiology and Immunology, Belgrade, Serbia

3 General hospital Euromedic, Belgrade, Serbia

4 Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia

5 University of Bari, Bari, Italy

6 Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijon, Spain

7 CHU de Nantes IMAD, Nantes, France

8 Gastrocentr, Perm, Russian Federation

9 Department of Gastroenterology, SM-clinic, Saint-Petersburg, Russian Federation

10 Department of Gastroenterology, GGP Bern, Department of Gastroenterology, Hirslanden Klinik Beau-Site, Bern, Switzerland

11 A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation

12 Department of Gastroenterology, Universidad de Oviedo, Oviedo, Spain

13 North-Western State Medical University n. a. I. I. Mechnikov, St. Petersburg, Russian Federation

14 Mechnikov North-Western State Medical University, Saint-Petersburg, Russian Federation

15 Department of Gastroenterology and Endoscopy, Department of Precision Medicine, Università Vanvitelli, Napoli, Italy

16 Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi University Hospital,, Bologna, Italy

17 Department of Gastroenterology, Hospital Universitario Virgen Macarena, Sevilla, Spain

18 Ferencvaros Health Centre, Budapest, Hungary

19 Department of Gastroenterology and Hepatology, General Hospital Zadar, Health Studies, University of Zadar, Zadar, Croatia

20 Division of Hepatogastroenterology, University of Campania "Luigi Vanvitelli", Naples, Italy

21 Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation

22 Cardiovascular Medicine Unit, Heart, Chest and Vascular Dept., IRCCS Azienda Ospedaliero-Universitaria di Bologna, Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Dept., University of Bologna, Bologna, Italy

23 University Centre Sestre Milosrdnice, Zagreb, Croatia

24 University Hospital Peter The Great, St. Petersburg, Russian Federation

25 Clinic for Gastroenterohepatology, University Clinical Centre of Serbia, Sabac, Stitar, Serbia

26 Hepato-Gastroenterology & Digestive Oncology Unit, University Hospital of Nantes, Nantes, France

27 UKC Tuzla, Tuzla, Bosnia and Herzegovina

28 Section of gastroenterology, DETO, University of Bari, Bari, Italy

29 Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

30 Hospital Cruz Roja Palma de Mallorca, Palma de Mallorca, Spain

31 Cardiovascular Medicine Unit, Heart, Chest and Vascular Dept., IRCCS Azienda Ospedaliero-Universitaria di Bologna, Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Dept., University of Bologna, Bologna, Italy

32 University Hospital Peter The Great, Saint-Petersburg, Russian Federation

33 Department of Gastroenterology, Hospital Universitario Son Espases, Palma de Mallorca, Spain

34 Fondazione Policlinico Universitario Gemelli IRCCS, Università’ Cattolica, Rome, Italy

35 Santos Reyes, Aranda de Duero, Spain

36 Department of Gastroenterology, Kantonsspital Aarau, Aarau, Switzerland

37 KBC SPLIT, Split, Croatia

38 Semmelweis University, Budapest, Hungary

39 Gastrointestinal Oncology, Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Spain

40 Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain

41 Department of Gastroenterology, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelon

42 Hopital Pellegrin, Laboratoire de Bacteriologie, Bordeaux, France

43 Trinity College Dublin - Faculty of Health Sciences, Trinity College Dublin; Dublin/IE, Dublin, Ireland

Summary

AI Generated

A European multicenter registry study using PCR-based testing found high rates of clarithromycin and fluoroquinolone resistance in H. pylori infections, with resistance escalating dramatically after multiple treatment attempts.

Among 265 H. pylori patients tested via PCR, treatment-naïve cases showed 31% clarithromycin resistance, 33% fluoroquinolone resistance, and 14% metronidazole resistance.
In rescue-line patients who had received at least one prior eradication attempt, clarithromycin resistance rose to 62% and fluoroquinolone resistance to 53%.
Multiple eradication attempts significantly increased clarithromycin resistance from 53% after second-line treatment to 79% after third-line and 100% after fourth-line treatment (p=0.001).
The authors conclude that the high resistance rates and steep increase following multiple attempts imply an urgent need for continuous antibiotic stewardship to optimize H. pylori eradication strategies.
This material is relevant for gastroenterologists managing H. pylori infections and considering antibiotic selection strategies.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

In light of the growing global problem of antibiotic resistance, eradication of clarithromycin (CLA)-resistant Helicobacter pylori (H. pylori) strains has been recognized as a top priority health problem. Poor antibiotic stewardship, and the complexity of antibiotic resistance patterns, has made H. pylori gastritis the most prevalent infectious disease. Pretreatment assessment of H. pylori antibiotic sensitivity has been suggested as a reasonable solution in overcoming antibiotic resistance and treatment failure.

Aims & Methods

The aim of the study was to assess the prevalence and pattern of H. pylori resistance towards most common prescribed antibiotics, through the use of molecular, PCR-based technique. A multicentric, prospective registry of the clinical practice of European gastroenterologists on the management of H. pylori (Hp-EuReg) collects since 2013 the real clinical practice of European gastroenterologists. Adults H. pylori-infected and PCR-tested patients registered at AEG REDCap e-CRF were analysed. Two types of molecular testing were performed: a non-invasive (stool sample PCR) and an invasive (gastric sample PCR) test.

Results

In total, 265 H. pylori patients were tested, of which 130 were treatment-naive cases and 135 had already received at least one eradication attempt. In treatment-naïve cases, CLA resistance (CLA-R) was 31%, fluoroquinolone resistance (FLQ-R) was 33% and metronidazole resistance (MET-R) was 14% (Table). There was no statistically significant difference in the bacterial resistance rate of tested antibiotics based on the gender and age distribution. In the rescue line, CLA-R was 62%, FLQ-R was 53% while MET-R was 7% (Table). Multiple eradication attempts significantly increased CLA-R (53% vs. 79% vs. 100%, for the 2^n,3^rdand 4^th line respectively, p=0.001).

Table. PCR-detected resistance to most common prescribed antibiotics in Europe.

Antibiotics	First line (n, %)	Rescue line (n, %)
Clarithromycin	40, 31%	84, 62%
Fluoroquinolones	43, 33%	72, 53%
Metronidazole	18, 14%	10, 7%

Conclusion

Alarmingly high H. pylori resistance to CLA and FLQ as well as its steep increase following multiple eradication attempts, implies an urgent need of continuous and systematic antibiotic stewardship, in order to further optimise H. pylori eradication strategies.

Disclosure

Olga P. Nyssen received research funding from Mayoly and Allergan. Javier P. Gisbert served as speaker, consultan, and advisory member for or received research funding from Mayoly, Allergan, Diasorin, Gebro Pharma, and Richen.

Conference

UEG Week Vienna 2024

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

H.PYLORI (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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