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. 2020 Oct 21;9(10):723.
doi: 10.3390/antibiotics9100723.

Helicobacter pylori Primary and Secondary Genotypic Resistance to Clarithromycin and Levofloxacin Detection in Stools: A 4-Year Scenario in Southern Italy

Giuseppe Losurdo  1   2 , Floriana Giorgio  3 , Maria Pricci  3 , Bruna Girardi  3 , Francesco Russo  4 , Giuseppe Riezzo  4 , Manuela Martulli  4 , Mariano Piazzolla  1 , Francesco Cocomazzi  1 , Francesco Abbruzzi  1 , Elisabetta Parente  1 , Rosa Paolillo  1 , Alessia Mileti  1 , Andrea Iannone  1 , Mariabeatrice Principi  1 , Enzo Ierardi  1 , Alfredo Di Leo  1
Affiliations

Helicobacter pylori Primary and Secondary Genotypic Resistance to Clarithromycin and Levofloxacin Detection in Stools: A 4-Year Scenario in Southern Italy

Giuseppe Losurdo et al. Antibiotics (Basel). .

Abstract

Antibiotic resistance has become an emerging problem for treating Helicobacter pylori (H. pylori) infection. Clarithromycin and levofloxacin are two key antibiotics used for its eradication. Therefore, we reviewed our experience with genotypic resistance analysis in stools to both clarithromycin and levofloxacin in the last four years to evaluate time trends, both in naive and failure patients. Patients collected a fecal sample using the THD fecal test device. Real-time polymerase chain reaction was performed to detect point mutations conferring resistance to clarithromycin (A2142C, A2142G, and A2143G in 23S rRNA) and levofloxacin (substitutions at amino acid position 87 and 91 of gyrA). One hundred and thirty-five naive patients were recruited between 2017-2020. Clarithromycin resistance was detected in 37 (27.4%). The time trend did not show any significant variation from 2017 to 2020 (p = 0.33). Primary levofloxacin resistance was found in 26 subjects (19.2%), and we observed a dramatic increase in rates from 2017 (10%) to 2018 (3.3%), 2019 (20%), and 2020 (37.8%). Ninety-one patients with at least one eradication failure were recruited. Secondary resistance to clarithromycin and levofloxacin was found in 59 (64.8%) and 45 patients (59.3%), respectively. In conclusion, our geographic area has a high risk of resistance to clarithromycin. There is also a progressive spreading of levofloxacin-resistant strains.

Keywords: Helicobacter pylori; antibiotic resistance; clarithromycin; levofloxacin; molecular analysis; stools.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Trends of clarithromycin and levofloxacin resistance in naive patients from 2017 to 2020. Histograms show rates and standard deviation. CLA-R: resistant to clarithromycin; LEVO-R: resistant to levofloxacin.
Figure 2
Figure 2
Trends of clarithromycin and levofloxacin resistance in patients with at least one eradication failure from 2017 to 2020. Histograms show rates and standard deviation. CLA-R: resistant to clarithromycin; LEVO-R: resistant to levofloxacin.
See this image and copyright information in PMC

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