title: Prospective multi-region study on primary antibiotic resistance of Helicobacter pylori strains isolated from Chinese patients.
abstract: BACKGROUND
  Large-scale multi-region studies are urgently needed to provide comprehensive and up-to-date information on the antibiotic resistance of Helicobacter pylori that is critical for selecting the most optimal eradication regimens.
  
  
  OBJECTIVE
  To determine the resistance patterns of Helicobacter pylori strains isolated from dyspeptic patients.
  
  
  METHODS
  This is a prospective, multicentre, cross-sectional, observational study. Helicobacter pylori cultures were successful in 600 patients (never receiving eradication therapy) from Northern, Eastern, Middle, and Southern regions between 2008 and 2012. Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin was determined by Epsilometer test.
  
  
  RESULTS
  The overall resistance rate was highest for metronidazole (403, 67.2%), followed by clarithromycin (225, 37.5%), levofloxacin (201, 33.5%), rifampicin (85, 14.2%), amoxicillin (41, 6.8%), and tetracycline (21, 3.5%). There were 16.3% isolates susceptible to all tested antibiotics, followed by mono-resistance (34.2%), double resistance (27.0%), triple resistance (16.8%), quadruple resistance (4.7%), quintuple resistance (0.7%) and sextuple resistance (0.3%). Independent factors influencing antibiotic resistance were gender (to levofloxacin), age (to levofloxacin), and endoscopic finding (to clarithromycin, metronidazole, and levofloxacin). Among the clarithromycin-resistant isolates, 75.6% and 48.0% were also resistant to metronidazole and levofloxacin, respectively.
  
  
  CONCLUSIONS
  Helicobacter pylori resistance to commonly used antibiotics in China is a very serious issue, due to the high resistance rate and general multiple resistance.
authors.affiliation: Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Song
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Lihua
authors.initials: L
authors.lastname: He
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of SunYat-sen University, Guangzhou, China.
authors.forename: Minhu
authors.initials: M
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Technology and Science, Wuhan, China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Hou
authors.affiliation: Department of Digestive Diseases, Changhai Hospital of Second Military Medical University, Shanghai, China.
authors.forename: Zhaoshen
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Peking University Third Hospital, Beijing, China. Electronic address: zhouliya123456@163.com.
authors.forename: Liya
authors.initials: L
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002681:China; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; China; Helicobacter pylori