High prevalence and risk factors of multiple antibiotic resistance in patients who fail first-line Helicobacter pylori therapy in southern China: a municipality-wide, multicentre, prospective cohort study

Abstract

Background We aimed to study the prevalence of secondary antibiotic resistance of Helicobacter pylori in southern China and its risk factors, particularly geographical and socio-economic factors. Methods This was a municipality-wide, multicentre, prospective cohort study involving five major hospitals. Patients aged ≥18 years who failed first-line bismuth-based quadruple anti-H. pylori therapy between September 2016 and February 2018 were recruited. Participants underwent upper gastrointestinal endoscopy with biopsy from the antrum and body for H. pylori culture and antimicrobial susceptibility testing for six antibiotics (clarithromycin, levofloxacin, metronidazole, amoxicillin, tetracycline and furazolidone). Patients with failure of H. pylori culture were excluded. Participants completed a questionnaire profiling 22 potential risk factors of H. pylori infection and antibiotic resistance, including medical, social, household and birthplace factors. Results A total of 1113 patients failed first-line therapy, with successful H. pylori culture in 791 (71.1%) [male = 433 (54.7%); median age = 43 years]. Secondary resistance rates of dual antibiotics (clarithromycin + metronidazole and levofloxacin + metronidazole) and triple antibiotics (clarithromycin + levofloxacin + metronidazole) were 34.0%, 38.7% and 17.8%, respectively. Risk factors for clarithromycin + metronidazole resistance were history of ≥2 courses of H. pylori therapies [adjusted OR (aOR) = 1.71; 95% CI = 1.17–2.54], ≥3 household members (aOR = 2.00; 95% CI = 1.07–3.90) and family history of gastric cancer (aOR = 1.85; 95% CI = 1.18–2.85). Risk factors for levofloxacin + metronidazole resistance were age ≥40 years (aOR = 1.94; 95% CI = 1.37–2.75), lower gross domestic product per capita (aOR = 0.29; 95% CI = 0.10–0.80) and higher number of doctors/10 000 population (aOR = 1.59; 95% CI = 1.07–2.39). A higher human development index was of borderline significance (aOR = 2.79; 95% CI = 0.97–8.70). Conclusions The rates of secondary resistance of H. pylori to multiple antibiotics were high in southern China. Certain population-level risk factors were associated with levofloxacin + metronidazole resistance.

Helicobacter pylori Infection in Geriatric Patients: Current Situation and Treatment Regimens

“…The elderly population is more likely to be resistant to antibiotics because of excessive use in the past ( 91 , 92 ). A multicenter cohort study showed that people aged >40 years were particularly at risk of developing dual drug resistance to levofloxacin and metronidazole ( 93 ). In case of chronic infectious bronchial pneumonia in the elderly, it is important to be wary of levofloxacin resistance, as they may have already been treated with quinolones or fluoroquinolones ( 94 ).…”

Clinical Strains of Helicobacter pylori With Strong Cell Invasiveness and the Protective Effect of Patchouli Alcohol by Improving miR-30b/C Mediated Xenophagy

“…Therefore, sufficient first-time treatment is crucial. The rates of secondary resistance of H. pylori to multiple antibiotics may attributed to the high invasion phenomenon (Lyu et al, 2020). Our results of the comparative study indicated that some clinical strains have stronger invasive ability than standard strains, and the intracellular invasion may be a survival strategy of H. pylori because intracellular environments allow bacteria to avoid immune cells or exposure to antimicrobials (Thakur et al, 2019).…”

Focusing on Helicobacter pylori infection in the elderly

“…In the elderly population with chronic respiratory or urinary tract infection, (fluoro)quinolone antibiotics are more commonly prescribed (Tandan et al, 2020). Lyu T et al (Lyu et al, 2020) showed that middle-aged and elderly patients had higher secondary resistance rates to metronidazole and levofloxacin in southern China. It is suggested to conduct drug susceptibility testing for H. pylori in the elderly population to select appropriate antibiotics.…”