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Meta-Analysis
. 2022 May 20;21(1):19.
doi: 10.1186/s12941-022-00509-3.

Heteroresistance to clarithromycin and metronidazole in patients with a Helicobacter pylori infection: a systematic review and meta-analysis

Ebrahim Kouhsari  1 , Nourkhoda Sadeghifard  2 , Arezoo Khadiv  2   3 , Hojjat Sayadi  4 , Taghi Amiriani  5 , Sobhan Ghafourian  2   3 , Hassan Valadbeigi  6 , Marcela Krutova  7
Affiliations
Meta-Analysis

Heteroresistance to clarithromycin and metronidazole in patients with a Helicobacter pylori infection: a systematic review and meta-analysis

Ebrahim Kouhsari et al. Ann Clin Microbiol Antimicrob. .

Abstract

Background: Antimicrobial resistance of H. pylori can lead to treatment failure. Importantly, several studies have reported on heteroresistance, i.e. the presence of resistant and susceptible H. pylori populations in the same sample and/or a difference in the susceptibility patterns between biopsy samples. This meta-analysis aims to provide comprehensive data on the prevalence of metronidazole and clarithromycin heteroresistance and the approaches to their detection.

Material and methods: A systematic review was performed after the search of MEDLINE, Scopus and Web of Science. The study outcomes were the weighted pooled prevalence of heteroresistance to clarithromycin and metronidazole in H. pylori positive samples and/or isolates with a subanalysis by continent.

Results: A total of 22 studies that had investigated 3852 H. pylori positive patients were included in the meta-analysis. Heteroresistance to clarithromycin was reported in 20 studies, with a weighted pooled prevalence of 6.8% (95% CI 5.1-8.6; 3654 H. pylori positive patients; the substantial heterogeneity I2 = 55.6%). Heteroresistance to metronidazole was reported in 12 studies, with a weighted pooled prevalence of 13.8% (95% CI 8.9-18.6; 1670 H. pylori positive patients; the substantial heterogeneity I2 = 60.9%). The weighted pooled prevalence of clarithromycin heteroresistance was similar in Asia and Europe (p = 0.174584), however, metronidazole heteroresistance was detected more often in Europe (p < 0.00001). Clarithromycin heteroresistance was detected more often by phenotype rather than by using genotyping methods (12 vs 8 studies), whereas heteroresistance to metronidazole was detected only by phenotype.

Conclusion: The prevalence of heteroresistance to clarithromycin and/or metronidazole is not negligible and can be detected in approximately 7 and 14% of H. pylori positive samples, respectively. These findings highlight the need to raise the awareness of gastroenterologists and microbiologists to the heteroresistance to clarithromycin and metronidazole in patients with a H. pylori infection.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study selection
Fig. 2
Fig. 2
Clarithromycin resistance in Helicobacter pylori-positive samples or isolates
Fig. 3
Fig. 3
Metronidazole resistance in Helicobacter pylori-positive samples or isolates
See this image and copyright information in PMC

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References

    1. Calvet X, Ramírez Lázaro MJ, Lehours P, Mégraud F. Diagnosis and epidemiology of Helicobacter pylori infection. Helicobacter. 2013;18:5–11. doi: 10.1111/hel.12071. - DOI - PubMed
    1. Crowe SE. Helicobacter pylori infection. N Engl J Med. 2019;380(12):1158–1165. doi: 10.1056/NEJMcp1710945. - DOI - PubMed
    1. IARC Working Group: Schistosomes liver flukes and Helicobacter pylori IARC working group on the evaluation of carcinogenic risks to humans Lyon, 7–14 June 1994. IARC Monogr Eval Carcinog Risks Hum. 1994;61:1–241. - PMC - PubMed
    1. Fallone CA, Moss SF, Malfertheiner P. Reconciliation of recent Helicobacter pylori treatment guidelines in a time of increasing resistance to antibiotics. Gastroenterology. 2019;157(1):44–53. doi: 10.1053/j.gastro.2019.04.011. - DOI - PubMed
    1. Blanchard TG, Nedrud JG. Laboratory maintenance of Helicobacter species. Curr Protoc Microbiol. 2006 doi: 10.1002/9780471729259.mc08b01s00. - DOI - PMC - PubMed

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