title: Evaluation of clinical and socio-demographic risk factors for antibacterial resistance of Helicobacter pylori in Bulgaria.
abstract: The aim of this study was to assess the clinical and socio-demographic risk factors for primary Helicobacter pylori antibacterial resistance. In total, 266 consecutive H. pylori strains, from untreated symptomatic adult patients who answered a questionnaire, were evaluated. Strain susceptibility to amoxicillin, metronidazole, clarithromycin and tetracycline was tested by a breakpoint susceptibility test. Metronidazole resistance was found in fewer (17.0 %) peptic ulcer patients than in non-ulcer subjects (28.3 %, P=0.037), as well as in fewer patients born in villages (12.7 %) than in those born in towns (27.6 %, P=0.016). Clarithromycin resistance varied from 8.8 to 23.4 % (P=0.009) within the hospital centres. The highest clarithromycin resistance rate was found in hospital centre A (23.4 %) compared to other centres (12.9 %, P=0.041). The factors sex, age, symptom duration, non-steroidal anti-inflammatory drug use, diabetes, type of profession and educational level were not associated with H. pylori resistance. Logistic regression revealed that the risk factors for metronidazole resistance were non-ulcer disease [odds ratio (OR) 1.95, 95 % confidence interval (95 % CI) 1.04-3.65] and a birthplace of a town (OR 2.64, 95 % CI 1.18-5.93). The hospital centre may be a risk factor (OR 2.07, 95 % CI 1.02-4.21) for clarithromycin resistance but further studies are required to verify this suggestion. In conclusion, the knowledge of the risk factors for H. pylori resistance to antibacterials could facilitate the treatment choice for H. pylori eradication.
authors.affiliation: Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria.
authors.forename: Lyudmila
authors.initials: L
authors.lastname: Boyanova
authors.affiliation: University Department of Social Medicine and Healthcare Management, Medical University of Sofia, Sofia, Bulgaria.
authors.forename: Juliana
authors.initials: J
authors.lastname: Ilieva
authors.affiliation: Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria.
authors.forename: Galina
authors.initials: G
authors.lastname: Gergova
authors.affiliation: Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria.
authors.forename: Zoya
authors.initials: Z
authors.lastname: Spassova
authors.affiliation: Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria.
authors.forename: Rossen
authors.initials: R
authors.lastname: Nikolov
authors.affiliation: Departments of Gastroenterology and General Surgery, University Hospital St Ekaterina, Sofia, Bulgaria.
authors.forename: Lubomir
authors.initials: L
authors.lastname: Davidkov
authors.affiliation: Departments of Gastroenterology and General Surgery, University Hospital St Ekaterina, Sofia, Bulgaria.
authors.forename: Ivailo
authors.initials: I
authors.lastname: Evstatiev
authors.affiliation: Urgent Endoscopy Unit, Emergency Hospital Pirogov, Sofia, Bulgaria.
authors.forename: Victor
authors.initials: V
authors.lastname: Kamburov
authors.affiliation: Second Surgery Department, University Alexander Hospital, Sofia, Bulgaria.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Katsarov
authors.affiliation: Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria.
authors.forename: Ivan
authors.initials: I
authors.lastname: Mitov
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002031:Bulgaria / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012959:Socioeconomic Factors
chemical_list: D000900:Anti-Bacterial Agents