Pattern of Primary Resistance of Helicobacter pylori to Clarithromycin among Pediatric Patients from North-Eastern Romania

Abstract

Background: Helicobacter pylori antibiotic resistance has increased worldwide and affects the effectiveness of current therapies. The recommended first-line empiric treatment should be tailored to the local clarithromycin resistance rate. This study aimed to determine the pediatric patient profile and rate of clarithromycin resistance for patients diagnosed with Helicobacter pylori by gastric biopsy. Methods: We studied 84 positive gastric samples for Helicobacter pylori. Positive results were confirmed by a rapid urease test and histopathological examination, with the type of gastritis established according to the Sydney System. Gastric biopsy samples were stored in RNA saver. Clarithromycin resistance was determined by a real-time polymerase chain reaction-based molecular assay after RNA-DNA extraction. Results: Of the 84 biopsy samples analyzed, 35 (41.6%) were resistant to clarithromycin. Clarithromycin resistance was found mainly in girls (80%) with a mean age of 15 years (range 6–17 years). The history of prior exposure to clarithromycin was 91.6%. The concordance between the histopathological examination and the PCR test was 100%. Conclusions: One in 2.4 children infected with Helicobacter pylori had a strain resistant to clarithromycin. This resistant strain may be a reason for treatment failure in Romanian children, yet this is uninvestigated. The high rate of bacterial resistance to this antibiotic among children indicates the need for susceptibility testing before therapy.

Antibiotic Resistance in Helicobacter pylori Isolates from Northwestern and Central Romania Detected by Culture-Based and PCR-Based Methods

“…Data about H. pylori antibiotic resistance in Europe are known [1,2,4,16,17], but only scarce data in Romania are available [11,12], with eradication treatments being empirical in most cases, yielding significant risks for infection relapse. As emphasized in the last Maastricht VI/Florence consensus report, clarithromycin is currently a key antibiotic to eradicate H. pylori, but when resistance is present, the probability of treatment success is low [6].…”

“…In Romania, according to several studies [7,8], the prevalence of H. pylori infection was higher than 50%, but more recent evidence suggests that this prevalence may actually be at a lower level, following a descendent trend [9,10]. However, there is still very limited published data about H. pylori resistance to antibiotics in adults or pediatric patients in Romania [9,11,12]. Nevertheless, the available information about other drug-resistant bacteria (Klebsiella, E. coli, Pseudomonas, Enterococcus) suggests alarming resistance rates (https://atlas.ecdc.europa.eu/, accessed on 18 September 2023), not always resembling those found in the neighboring countries [13][14][15].…”