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IRISH HELICOBACTER PYLORI ANTIBIOTIC RESISTANCE SURVEILLANCE TO GUIDE CLINICAL PRACTICE

Thomas Butler 1,2, Stephen Molloy 1, Conor Costigan 1,2, Kevin Van Der Merwe 3, Vikrant Parihar 3, Serhiy Semenov 4, Sharon Hough 5, David Kevans 5, Donal Tighe 4, Deirdre McNamara 2, Sinead Smith 1,2

Affiliations

1 Trinity College Dublin, Dublin, Ireland

2 Tallaght University Hospital, Dublin, Ireland

3 Letterkenny University Hospital, Letterkenny, Ireland

4 Mayo University Hospital, Co. Mayo, Ireland

5 St James's Hospital, Dublin, Ireland

Summary

AI Generated

A multisite Irish study of 126 H. pylori isolates found primary resistance rates of 37.9% for clarithromycin and 44.7% for metronidazole, leading authors to conclude that first-line clarithromycin triple therapy can no longer be recommended in Ireland.

Primary resistance rates were 37.9% for clarithromycin, 44.7% for metronidazole, 21.4% for levofloxacin, 33.3% for amoxicillin, 16.7% for rifampicin, and 10.7% for tetracycline among 103 treatment-naïve patients.
Secondary resistance rates in 23 previously treated patients reached 65.2% for clarithromycin and 73.9% for metronidazole, nearly double the primary resistance rates.
The study collected gastric biopsies from four sites comprising two urban and two rural teaching hospitals in Ireland, with antibiotic susceptibility testing performed by E-test using EUCAST clinical breakpoints.
Authors concluded that antibiotic resistance rates have reached significant levels for all major classes of antibiotics used to treat H. pylori in Ireland.
The findings are intended to guide national treatment strategies, addressing the fact that H. pylori antibiotic resistance testing is not routinely carried out in the majority of Irish hospitals.

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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

Antibiotic resistance is one of the main reasons for H. pylori treatment failure. International guidelines recommend that the choice of antibiotics used to treat H. pylori in a given population should be based on the pattern of antibiotic resistance in that region. However, H. pylori antibiotic resistance testing is not routinely carried out in the majority of Irish Hospitals. Recent evidence from the European Helicobacter and Microbiota Study Group has indicated that resistance to certain commonly used antibiotics to eradicate H. pylori varies between European countries, and in certain areas resistance has reached a sufficient level to avoid prescribing these antibiotics as empirical therapy (1). In addition, previous antibiotic use positively correlates with resistance for two major classes of antibiotics commonly used to treat H. pylori infection (1). Because antibiotic resistance is a constantly evolving process, the European Helicobacter and Microbiota Study Group and the Maastricht VI/Florence consensus report (2) have highlighted the importance for local resistance surveys to be carried out on a regular basis in order to guide clinicians in their choice of therapy for successful eradication of H. pylori.

Aims & Methods

In this multisite study we aimed to assess the rate of primary and secondary antibiotic resistance for H. pylori in Ireland, with a view to guiding national treatment strategies. The study comprised of four sites with samples analyzed from two large urban teaching hospitals and two rural teaching hospitals. Patients attending for gastroscopy were invited to participate in the study. Following informed consent, 1 antrum and 1 corpus gastric biopsy were collected from each patient and transported to the laboratory in selective medium. Antibiotic susceptibility testing was carried out by E-test (bioMerieux) and resistance classified according to the EUCAST clinical breakpoints MIC values.

Results

In total, 126 isolates were successfully cultured and antimicrobial susceptibility assessed. 103 of these were isolates of treatment naïve patients (50±16 years old, 59% male) and 23 were of previously treated patients (48±12 years old, 61% female). As can be seen in table 1, primary antibiotic resistance rates have reached alarmingly high levels for both clarithromycin and metronidazole, and reach nearly double the rate of resistance with the previously treated group.

Table 1: Antibiotic susceptibility rates for H. pylori isolated from Irish Hospitals
Antibiotic	clarithromycin	metronidazole	levofloxacin	tetracycline	amoxicillin	rifampicin
Primary Resistance (%)	37.9	44.7	21.4	10.7	33.3	16.7
Secondary Resistance (%)	65.2	73.9	30.4	17.4	30.4	17.4

Conclusion

Antibiotic resistance rates have reached significant levels for all major classes of antibiotics for the treatment of H. pylori. Of note, first-line clarithromycin triple therapy can no longer be recommended in Ireland.

References

(1) Megraud F et al. Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community. Gut. 2021
(2) Malfertheiner P, et al Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report Gut 2022;71:1724-1762.
(3) Smith, S. et al. The Irish Helicobacter pylori Working Group consensus for the diagnosis and treatment of H. pylori infection in adult patients in Ireland. Eur. J. Gastroenterol. Hepatol. 29, 552–559 (2017).