Audit ofHelicobacter pyloriTesting in Microbiology Laboratories in England: To Inform Compliance with NICE Guidance and the Feasibility of Routine Antimicrobial Resistance Surveillance.
Introduction. The National Institute for Health and Clinical Excellence (NICE) guidance recommends that dyspeptic patients are tested forHelicobacter pyloriusing a urea breath test, stool antigen test, or serology. Antibiotic resistance inH. pyloriis globally increasing, but treatment in England is rarely guided by susceptibility testing or surveillance.Aims. To determine compliance of microbiology laboratories in England with NICE guidance and whether laboratories perform culture and antibiotic susceptibility testing (AST).Methods. In 2015, 170 accredited English microbiology laboratories were surveyed, by email.Results. 121/170 (71%) laboratories responded; 96% providedH. pyloritesting (78% on site). 94% providedH. pyloridiagnosis using stool antigen; only four provided serology as their noninvasive test; 3/4 of these encouraged urea breath tests in their acute trusts. Only 22/94 (23%) of the laboratories performedH. pyloricultures from gastric biopsies on site; 9/22 performed AST, but the vast majority processed less than one specimen/week.Conclusions. Only five laboratories in England do not comply with NICE guidance; these will need the guidance reinforced. National surveillance needs to be implemented; culture-based AST would need to be centralised. Moving forward, detection of resistance inH. pylorifrom stool specimens using molecular methods (PCR) needs to be explored.
Primary Care Unit, Public Health England, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
Rosalie
R
Allison
Primary Care Unit, Public Health England, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
Donna M
DM
Lecky
Histology Department, Cheltenham General Hospital, Sandford Rd., Cheltenham, Gloucestershire GL53 7AN, UK.
Megan
M
Bull
2gether NHS Foundation Trust, Rikenel, Montpellier, Gloucester GL1 1LY, UK.
Kim
K
Turner
Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Gauri
G
Godbole
Primary Care Unit, Public Health England, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
Cliodna A M
0000-0003-4969-5360
CA
McNulty