Antibiotic resistance, heteroresistance, and eradication success ofHelicobacter pyloriinfection in children

Abstract

BackgroundAntibiotic resistance is a well‐known factor of Helicobacter pylori eradication failure. Heteroresistance indicates the coexistence of resistant and susceptible strains and might lead to underestimating antimicrobial resistance. This study aims to evaluate the susceptibility profile, the frequency of heteroresistance of H. pylori strains, and their effect on eradication success in a pediatric population.Materials and MethodsChildren aged 2–17 years who underwent an upper gastrointestinal endoscopy from 2011 to 2019 with positive H. pylori status were included. Susceptibility was measured by disk diffusion and E‐test. The difference in susceptibility profiles between isolates from the antrum and the corpus was used to detect heteroresistance. For those who received eradication treatment, we evaluated eradication rate and factors affecting treatment success.ResultsInclusion criteria were met by 565 children. Strains susceptible to all antibiotics were detected in 64.2%. Primary resistance rates for clarithromycin (CLA), metronidazole (MET), levofloxacin (LEV), tetracyclin (TET), and amoxicillin (AMO) were 11%, 22.9%, 6.9%, 0.4%, and 0% and secondary resistance rates were 20.4%, 29.4%, 9.3%, 0%, and 0%. Heteroresistance was present in untreated children in 2%, 7.1%, 0.7%, 0.7%, and 0% for CLA, MET, LEV, TET, and AMO. First‐line eradication rates were 78.5% in intention‐to‐treat (ITT), 88.3% in full‐analysis‐set (FAS), and 94.1% in per‐protocol (PP). Factors affecting eradication success were the duration of treatment when the triple‐tailored treatment was used, the number of daily doses of amoxicillin administered, and the patient's adherence to treatment.ConclusionsThis study shows the presence of relatively low primary resistance rates for H. pylori isolates but demonstrates the presence of heteroresistance in our population. Routine biopsies from the antrum and corpus must be considered for susceptibility testing to allow tailored treatments and increase eradication rates. Treatment success is affected by treatment choice, correct dosing of medications, and adherence. All these factors should be considered when evaluating the efficacy of an eradication regimen.

Rapid Non-Invasive Techniques for Detecting Antibiotic Resistance in Helicobacter pylori: An Update and Clinical Applications

“…Then, filter paper disks impregnated with standardized concentrations of a few different antibiotics are placed on the surface of predefined areas. The plates are incubated as described for the agar dilution method, and the size of the zone of inhibition around each of the disks is measured after 72 h [7,10]. However, this method has a labor-intensive nature stemming from manual measurements and data documentation, and mainly relies on investigator skill, leading to potential variations in results [38,39].…”

“…When compared to the agar dilution or broth dilution procedures, the E-test is straightforward to execute, and the results have been found to correlate closely with results obtained by the gold standard (agar dilution), except for metronidazole, for which recent studies have revealed inconsistency in the results [11]. The E-test possesses all the disadvantages that the disk diffusion method does [7,10,11].…”

“…Currently, conventional culture-based microbiological methods are commonly used to determine the susceptibility of H. pylori strains to various recommended antibiotics [7][8][9][10][11]. However, these methods are tedious, time-consuming, costly, and, more importantly, invasive.…”

A rapid and high-throughput multiplex genetic detection assay for detection, semi-quantification and virulence genotyping of Helicobacter pylori in non-invasive oral samples

“…Patients who underwent upper gastrointestinal endoscopy due to recurrent upper gastrointestinal symptoms of abdominal pain, acid reflux, vomiting or abdominal distention, and chronic gastritis, peptic ulcer or gastric cancer with family history, were included (Kotilea et al, 2023). Patients who received anti-H. pylori therapy within 4 weeks preceding the study, experienced subtotal gastrostomy, suffered from severe cardiovascular and respiratory diseases or recently consumed NSAID or alcohol, were excluded (Kotilea et al, 2023). In addition, all included patients did not brush their teeth or drink water in the morning.…”

1,3,6-Trigalloylglucose: A Novel Potent Anti-Helicobacter pylori Adhesion Agent Derived from Aqueous Extracts of Terminalia chebula Retz

“…The literature outlines numerous extra-digestive diseases potentially linked to HP infection, spanning neurological, dermatological, hematologic, ocular, cardiovascular, metabolic, and allergic conditions [ 15 , 16 , 17 , 18 ]. While some associations lack a clear explanation of the pathogenic mechanism, others exhibit a strong correlation, prompting guidelines for the treatment of HP infection to recommend determination and eradication therapy in these circumstances [ 19 ]. Overall, the implications of HP infection extend far beyond the digestive system, presenting a complex array of potential health consequences that continue to engage scientific inquiry and clinical attention.…”