Culture-based antibiotic susceptibility testing for Helicobacter pylori infection: a systematic review

Abstract

Background Primary antibiotic resistance in Helicobacter pylori ( H. pylori ) strains is increasing worldwide, affecting therapy success. The use of therapies tailored on susceptibility pre-testing at culture has been proposed, but data are still conflicting. Method We performed a systematic review to evaluate the role of a culture-based therapeutic approach for H. pylori treatment, taking into account the sensitivity of culture and the success rates achieved with tailored therapies in different therapeutic steps. Results We analyzed data from 51 studies. Overall, H. pylori strains were isolated in 80.7% of 7889 patients, the success rates being 78.1%, 77.5%, 86.3% and 86.6%, before first-, second-, third-line or more therapies, respectively. In comparative studies, the infection was cured in 89.9% of 2052 patients treated with tailored therapies, and in 77.6% of 2516 patients receiving empiric therapy (P<0.001). However, in the subanalysis, the tailored approach achieved optimal eradication rates (>90%) only when it was applied before first- and second-line therapies, but not before third-line or more attempts (<80%). Moreover, no significant difference emerged between the 2 approaches when data from only the most recent (last 5 years) studies were considered, as well as in those performed in Western populations. Conclusions The attempt to achieve antibiotic susceptibility testing before treatment failed in 20% of infected patients managed in dedicated laboratories. Culture-tailored therapies administered after 2 or more therapies achieved suboptimal eradication rates. The role of bacterial culture in patients whose therapeutic management failed to eradicate H. pylori probably needs to be corroborated by further data.

Helicobacter pylori culture: from bench to bedside

“…Finally, it has been suggested that more studies were required to demonstrate the theoretical expected superiority of antimicrobial susceptibility testing-guided therapy over empiric therapy [ 24 , 43 ]. However, this goal is difficult to achieve, as these studies are very expensive.…”

“…When antibiotic susceptibility testing was attempted in patients with a documented infection by another test, the success rate varied according to the setting. In detail, the pooled-data analysis of 51 studies showed that H. pylori strains were isolated overall in 80.7% of 7889 patients, with success rates of 78.1%, 77.5%, 86.3%, and 86.6% before first-, second-, third-line or more therapies, respectively [ 24 ]. Therefore, the attempt to acquire information on bacterial resistance failed in more than 20% of cases, even though the infection was present.…”

“…A recent systematic review of comparative studies showed that H. pylori infection was cured in 89.9% of 2052 patients treated with antibiotic tailored therapies and in 77.6% of 2516 patients receiving empiric therapy (P<0.001) [ 24 ]. However, in the sub-analysis, acceptably high eradication rates with tailored therapies were achieved only when the approach was applied before either first- (91.6% vs. 78.2%) or second-line (91.2% vs. 79%) therapies, but not before third-line treatment (79% vs. 70%), that is for the step suggested in all current guidelines.…”

Unravelling the In Vitro and In Vivo Anti-Helicobacter pylori Effect of Delphinidin-3-O-Glucoside Rich Extract from Pomegranate Exocarp: Enhancing Autophagy and Downregulating TNF-α and COX2

“…H. pylori infection causes chronic active gastritis, peptic ulcer, and gastric mucosa-associated lymphoma. Consequently, this pathogen has been classified by the WHO as a class I carcinogen which could promote gastric cancer [ 3 ]. Infection by H. pylori was reported in the literature in both children and adults [ 4 , 5 ].…”

“…Emergence of drug resistance represents a major challenge for eradicating this microbe despite the efficiency of the triple-management protocol followed in the empirical therapy of H. pylori infections [ 3 , 7 ]. In this respect, natural products exhibiting antimicrobial activities against such a pathogen might have a great potential for treating infections triggered by this microbe.…”