Multicenter Survey of Routine Determinations of Resistance of Helicobacter pylori to Antimicrobials over the Last 20 Years (1990 to 2009) in Belgium

Abstract

We analyzed the rates of antimicrobial resistance of Helicobacter pylori strains isolated from patients from 1990 to 2009 and identified risk factors associated with resistance. Gastric biopsy specimens were collected from several digestive disease centers in Brussels, Belgium. We routinely performed antimicrobial susceptibility testing for clarithromycin (CLR), metronidazole, amoxicillin, tetracycline, and ciprofloxacin. Evaluable susceptibility testing was obtained for 9,430 strains isolated from patients who were not previously treated for Helicobacter pylori infection (1,527 isolates from children and 7,903 from adults) and 1,371 strains from patients who were previously treated (162 isolates from children and 1,209 from adults). No resistance to amoxicillin was observed, and tetracycline resistance was very rare (<0.01%). Primary metronidazole resistance remained stable over the years, with significantly lower rates for isolates from children (23.4%) than for isolates from adults (30.6%). Ciprofloxacin resistance remained rare in children, while it increased significantly over the last years in adults. Primary clarithromycin resistance increased significantly, reaching peaks in 2000 for children (16.9%) and in 2003 for adults (23.7%). A subsequent decrease of resistance rates down to 10% in both groups corresponded to a parallel decrease in macrolide consumption during the same period. Multivariate logistic regression revealed that female gender, age of the patient of 40 to 64 years, ethnic background, the number of previously unsuccessful eradication attempts, and the different time periods studied were independent risk factors of resistance to clarithromycin, metronidazole, and ciprofloxacin. Our study highlights the need to update local epidemiological data. Thus, the empirical CLR-based triple therapy proposed by the Maastricht III consensus report remains currently applicable to our population.

Changes in Antibiotic Susceptibility ofHelicobacter pyloriin the Course of Eight Years in the Zaanstreek Region in The Netherlands

“…Primary clarithromycin resistance increased significantly, reaching peaks in 2000 for children (16.9%) and in 2003 for adults (23.7%). A subsequent decrease of the resistance rate down to 10% in both groups corresponded to a parallel decrease in macrolide consumption during the same period [13]. In accordance with this paper, Figure 2 shows a gradual increase in bacterial susceptibility in the course of the study period especially for clarithromycin.…”

Sequential Therapy for Helicobacter pylori Infection in Treatment‐naïve Children

“…The primary resistance rate to CLA and to MET was even lower compared to the survey ten years ago . This decline was basically due to a reduced CLA resistance rate in some Western countries such as Belgium and France which successfully reduced the use of the newer macrolides . Otherwise the same risk factors for primary resistance could be identified in this small cohort as in the large European cohort sampled a decade ago in which living in Southern Europe was the strongest risk factor for resistance to CLA and coming from a migrant family a risk factor for resistance to MET.…”

“…Successful cure of the infection depends on the combination of drugs, their doses, the formulation, the duration of therapy, the adherence to therapy, and the strain susceptibility to antibiotics used in the regimen . The overuse of antibiotics in general and inappropriate or ineffective treatment regimens for H. pylori infections have led to a high proportion of strains with resistance to antibiotics such as clarithromycin, metronidazole, and levofloxacin used to treat this infection . Treatment regimens for first‐line therapy should provide a cure rate of at least 90%, preferably above 95% .…”

Numerous risk factors for Helicobacter pylori antibiotic resistance revealed by extended anamnesis: a Bulgarian study

“…A study in Belgium, where tetracycline resistance is rare, showed the female sex to be associated with H. pylori resistance to clarithromycin, metronidazole and ciprofloxacin (Miendje Deyi et al, 2011).…”