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. 2021 Sep 1;10(9):1058.
doi: 10.3390/antibiotics10091058.

Antibiotic Resistance Prevalence and Trends in Patients Infected with Helicobacter pylori in the Period 2013-2020: Results of the European Registry on H. pylori Management (Hp-EuReg)

Luis Bujanda  1 , Olga P Nyssen  2 , Dino Vaira  3 , Ilaria M Saracino  3 , Giulia Fiorini  3 , Frode Lerang  4 , Sotirios Georgopoulos  5 , Bojan Tepes  6 , Frederic Heluwaert  7 , Antonio Gasbarrini  8 , Theodore Rokkas  9 , Dmitry Bordin  10   11   12 , Sinead Smith  13 , Vincent Lamy  14 , María Caldas  2 , Elena Resina  2 , Raquel Muñoz  2 , Ángel Cosme  1 , Ignasi Puig  15 , Francis Megraud  16 , Colm O'Morain  13 , Javier P Gisbert  2 ; The Hp-EuReg Investigators
Collaborators, Affiliations

Antibiotic Resistance Prevalence and Trends in Patients Infected with Helicobacter pylori in the Period 2013-2020: Results of the European Registry on H. pylori Management (Hp-EuReg)

Luis Bujanda et al. Antibiotics (Basel). .

Abstract

Background: Bacterial antibiotic resistance changes over time depending on multiple factors; therefore, it is essential to monitor the susceptibility trends to reduce the resistance impact on the effectiveness of various treatments. Objective: To conduct a time-trend analysis of Helicobacter pylori resistance to antibiotics in Europe. Methods: The international prospective European Registry on Helicobacter pylori Management (Hp-EuReg) collected data on all infected adult patients diagnosed with culture and antimicrobial susceptibility testing positive results that were registered at AEG-REDCap e-CRF until December 2020. Results: Overall, 41,562 patients were included in the Hp-EuReg. Culture and antimicrobial susceptibility testing were performed on gastric biopsies of 3974 (9.5%) patients, of whom 2852 (7%) were naive cases included for analysis. The number of positive cultures decreased by 35% from the period 2013-2016 to 2017-2020. Concerning naïve patients, no antibiotic resistance was found in 48% of the cases. The most frequent resistances were reported against metronidazole (30%), clarithromycin (25%), and levofloxacin (20%), whereas resistances to tetracycline and amoxicillin were below 1%. Dual and triple resistances were found in 13% and 6% of the cases, respectively. A decrease (p < 0.001) in the metronidazole resistance rate was observed between the 2013-2016 (33%) and 2017-2020 (24%) periods. Conclusion: Culture and antimicrobial susceptibility testing for Helicobacter pylori are scarcely performed (<10%) in Europe. In naïve patients, Helicobacter pylori resistance to clarithromycin remained above 15% throughout the period 2013-2020 and resistance to levofloxacin, as well as dual or triple resistances, were high. A progressive decrease in metronidazole resistance was observed.

Keywords: Helicobacter pylori; amoxicillin; antibiotic resistance; clarithromycin; levofloxacin; metronidazole; tetracycline.

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Conflict of interest statement

Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from Mayoly Spindler, Allergan, Diasorin, Gebro Pharma, and Richen. Olga P. Nyssen received research funding from Allergan and Mayoly Spindler. Dmitry Bordin served as a lecturer for Astellas, AstraZeneca, KRKA, and Abbott. Francis Megraud is a consultant for PHATHOM, DaVoltera and received grants from Allergan, bioMerieux, and Mobidiag. The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patients included in the study.
Figure 2
Figure 2
Evolution of Helicobacter pylori antibiotic resistance in naïve patients over the past eight years (A) and according to study periods: 2013–2016 and 2017–2020 (B).
See this image and copyright information in PMC

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