Evaluation of clinical and socio-demographic risk factors for antibacterial resistance of Helicobacter pylori in Bulgaria.
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.
Boyanova
Lyudmila
L
Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria.
Ilieva
Juliana
J
University Department of Social Medicine and Healthcare Management, Medical University of Sofia, Sofia, Bulgaria.
Gergova
Galina
G
Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria.
Spassova
Zoya
Z
Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria.
Nikolov
Rossen
R
Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria.
Davidkov
Lubomir
L
Departments of Gastroenterology and General Surgery, University Hospital St Ekaterina, Sofia, Bulgaria.
Evstatiev
Ivailo
I
Departments of Gastroenterology and General Surgery, University Hospital St Ekaterina, Sofia, Bulgaria.
Kamburov
Victor
V
Urgent Endoscopy Unit, Emergency Hospital Pirogov, Sofia, Bulgaria.
Katsarov
Nikolai
N
Second Surgery Department, University Alexander Hospital, Sofia, Bulgaria.
Mitov
Ivan
I
Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria.
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
D000900:Anti-Bacterial Agents