Antibiotic resistance status of helicobacter pylori strains isolated from initial eradication patients in Ningbo, China, from 2017 to 2021

Abstract

Background Resistance of Helicobacter pylori (H. pylori) to antibiotics is an evolving and dynamic process. Presence of antibiotic resistance impacts the success rate of initial eradication strategies in the clinic. Aim To improve the success rate of initial eradication therapy and explore new antibiotic regimens, a large sample‐based study utilizing antimicrobial susceptibility testing was performed. A total of 2508 H. pylori strains from patients subjected to initial eradication therapy were isolated, cultured, and tested for drug susceptibility from 2017 to 2021. The minimal inhibitory concentration (MIC) was recorded. H. pylori susceptibility profiles and its change trends from initial eradication patients were analyzed. The relationships between drug resistance, year of sample collection, age, and sex of patients were analyzed. Results The overall resistance rates were as follows: amoxicillin (9.25%), clarithromycin (38.48%), levofloxacin (42.86%), furazolidone (11.28%), doxycycline (8.56%), rifampicin (10.81%), tinidazole (74.32%), gatifloxacin (61.71%), tetracycline (0%), metronidazole (78.71%), ornidazole (97.87%), and fosfomycin (31.67%). Only 38.04% of the strains were pansusceptible to amoxicillin, clarithromycin, levofloxacin, and furazolidone, followed by those of mono resistance (29.90%), double resistance (24.96%), triple resistance (6.34%), and quadruple resistance (0.76%). Significant differences in the resistance rate and MIC were also observed in different age and sex groups. Time of collection and patient age and sex were associated with the distribution of antibiotic resistance. Conclusion With the increasing resistance rate and multiple resistance of H. pylori to commonly used antibiotics, drug susceptibility testing is imperative to permit individualized therapy, and a regimen containing the combination of amoxicillin, furazolidone, tetracycline, doxycycline, or rifampicin is reasonable for initial empirical eradication therapy.

Antibiotic resistance in Helicobacter pylori: From potential biomolecular mechanisms to clinical practice

“…Doxycycline is a TET antibiotic. In China, the doxycycline‐resistance rate in H. pylori was 8.56% 111 . Similarly, doxycycline has a low resistance rate in other regions, such as Sweden and Cameroon, with rates of 1.4% 112 and 5%, 18 respectively.…”

“…In recent years, they have rarely been used in H. pylori eradication therapy because of their high drug resistance rate. For example, some statistics show that the tinidazole‐resistance rate in China was 74.32% 111 and that in Nigeria, it was as high as 100% 68 . As for ornidazole, its resistance rate was also up to 97.87% in China 111 .…”

“…For example, some statistics show that the tinidazole‐resistance rate in China was 74.32% 111 and that in Nigeria, it was as high as 100% 68 . As for ornidazole, its resistance rate was also up to 97.87% in China 111 . In general, in addition to use based on drug susceptibility testing, ornidazole, and tinidazole have lost their clinical application value as the empirical treatment for H. pylori infection.…”

“…In China, the doxycycline‐resistance rate in H. pylori was 8.56%. 111 Similarly, doxycycline has a low resistance rate in other regions, such as Sweden and Cameroon, with rates of 1.4% 112 and 5%, 18 respectively. In terms of eradication efficacy, doxycycline‐containing quadruple therapy has an ideal effect, which is as high as 93.8% eradication success rate as an initial treatment in patients.…”

“… 68 As for ornidazole, its resistance rate was also up to 97.87% in China. 111 In general, in addition to use based on drug susceptibility testing, ornidazole, and tinidazole have lost their clinical application value as the empirical treatment for H. pylori infection.…”