title: Trends in secondary antibiotic resistance of Helicobacter pylori from 2007 to 2014: has the tide turned?
abstract: The current guidelines recommend culture and antibiotic susceptibility testing of Helicobacter pylori following two failed eradication attempts. Where testing is unavailable, epidemiological data for secondary H. pylori resistance are essential to allow for the rational use of antibiotics. The aim of this study was to describe the temporal changes in antibiotic resistance among adults previously treated for H. pylori infections and to identify predictors of resistance. Between 2007 and 2014, consecutive patients undergoing gastroscopy with H. pylori culture and susceptibility testing at our institution following at least two treatment failures were retrospectively identified. Antibiotic susceptibilities were recorded and linked to the demographic data. A total of 1,042 patients were identified, including 739 (70.9%) males, aged 39.3 ± 18.9 years. Resistance to clarithromycin, metronidazole, and levofloxacin was found in 57.2%, 64.4%, and 5.1% of isolates, respectively. Dual resistance to clarithromycin and metronidazole was seen in 39.9%. Over the study period, clarithromycin resistance increased annually in a linear manner (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03 to 1.14; P < 0.01), levofloxacin resistance decreased annually (OR, 0.78; 95% CI, 0.61 to 0.92; P < 0.01), and metronidazole resistance was nonlinear. Age was an independent predictor of resistance to all antibiotics. Time elapsed predicted resistance for clarithromycin and levofloxacin and dual resistance for clarithromycin-metronidazole. Secondary resistance of H. pylori to clarithromycin and metronidazole remains high. The low secondary resistance to levofloxacin makes it an attractive treatment option in our region for patients following two failed eradication attempts.
authors.affiliation: Department of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel dboltin@gmail.com.
authors.forename: Doron
authors.identifier: http://orcid.org/0000-0003-3357-613X
authors.initials: D
authors.lastname: Boltin
authors.affiliation: Department of Clinical Microbiology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Ben-Zvi
authors.affiliation: Gastroenterology Laboratory, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Tsachi Tsadok
authors.initials: TT
authors.lastname: Perets
authors.affiliation: Department of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Kamenetsky
authors.affiliation: Department of Clinical Microbiology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Zmira
authors.initials: Z
authors.lastname: Samra
authors.affiliation: Department of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Ram
authors.initials: R
authors.lastname: Dickman
authors.affiliation: Department of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D017291:Clarithromycin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology* / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D064704:Levofloxacin / Q000494:pharmacology; D008297:Male; D008795:Metronidazole / Q000494:pharmacology; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D064704:Levofloxacin; D017291:Clarithromycin