Analysis of Helicobacter pylori resistance in patients with different gastric diseases

Abstract

Helicobacter pylori (H. pylori) resistance is the most important risk factor for eradication failure. However, in most regions, antibiotic resistance rates of H. pylori in patients with different types of gastric mucosal lesions are still unclear. An 8-year clinical retrospective cohort study involving 2847 patients was performed. In this study, we first summarized and compared the resistance status of H. pylori in different years, ages, sexes, and gastric diseases. The resistance profiles of amoxicillin (AMX), clarithromycin (CLR), levofloxacin (LVX) and furazolidone (FR) and their changing trends in the clinic were described. Then, multiple antibiotic resistance in different gastric diseases and years were described and compared. The relationship between proton pump inhibitor (PPI) medication history and antibiotic resistance in H. pylori was also explored. Finally, an antibiotic resistance risk model was constructed for clinical resistance risk prediction. The overall resistance rates of AMX, CLR, LVX and FR in gastric diseases were 8.18%, 38.11%, 43.98%, and 13.73%, respectively. The mono resistance, double resistance, triple resistance, and quadruple resistance rates were 30.17%, 25.96%, 6.46%, and 0.63%, respectively. Compared with the period from 2014 to 2016, the rates of mono-resistance and multiple resistance all showed relatively downward trends in the past 5 years. Factors including age, sex, type of gastric lesions and recent PPI treatment history are associated with the antibiotic resistance rate of H. pylori. Atrophic gastritis is an important clinical feature of high-risk antibiotic resistance in H. pylori-infected patients. Patients with atrophic gastritis have higher risk of resistant strains infection. In this study, our data provide the association between antibiotic resistance of H. pylori and gastritis pattern, which indicate the higher risk of resistant strain infection if the patients with atrophic gastritis, PPI history and older age.

Keywords: Helicobacter pylori; Antibiotic resistance; Antimicrobial susceptibility test; Atrophic gastritis; Proton pump inhibitor.

Figure 1

Nomogram development for antibiotic resistance risk. Nomogram models were constructed to predict the risk of amoxicillin (A), clarithromycin (B), levofloxacin (C) and furazolidone (D). Calibration curves reflected good discriminative ability of models for amoxicillin (E), clarithromycin (F), levofloxacin (G) and furazolidone (H). Individual factors such as age, sex, PPI treatment history and gastric disease are all incorporated into antibiotic resistance prediction models. In clinical practice, users can calculate total points of the model based on individual factors, and then conveniently obtain the probability data of specific antibiotic resistance to predict the individual risk. For example, a 45 year-old man with PPI history and his endoscopic finding was atrophic gastritis, the risk of clarithromycin resistance will exceed 60%. Therefore, clarithromycin should not be prioritized for use, and bismuth-containing quadruple therapy should be considered as the first line empirical treatment for this patient according to Maastricht consensus. SG, superficial gastritis; EG, erosive gastritis; PU, peptic ulcer; AG, atrophic gastritis; IN, intraepithelial neoplasia.