Trends in Primary Antibiotic Resistance in <i>H. pylori</i> Strains Isolated in Italy between 2009 and 2019

• Main Authors: Ilaria Maria Saracino, Giulia Fiorini, Angelo Zullo, Matteo Pavoni, Laura Saccomanno, Dino Vaira
• Format: Article
• Language: English
• Published: MDPI AG 2020-01-01
• Series: Antibiotics
• Subjects: <i>h. pylori</i>; antibiotic resistance; first line therapy
• Online Access: https://www.mdpi.com/2079-6382/9/1/26

Background and aims: the increasing prevalence of strains resistant to antimicrobial agents is a critical issue for the management of <i>Helicobacter pylori</i> infection. This study aimed to evaluate, in Italian na&#239;ve patients, <i>H. pylori</i> antibiotic resistance trends and their potential predictive factors during the last decade. Methods: consecutive Italian na&#239;ve <i>H. pylori</i> positive patients, referred from General Practitioners to our Unit from January 2009 to January 2019 to perform an upper gastrointestinal endoscopy (UGIE), were considered. Each patient underwent ¹³C-urea breath test (¹³C-UBT) and UGIE with multiple biopsies to perform rapid urease test (RUT), culture/susceptibility test (vs. clarithromycin, metronidazole, levofloxacin), and histopathological examination. <i>H. pylori</i> status was assessed through CRM (composite reference method: at least two tests positive or only culture positive). Results: between 2009 and 2014, 1763 patients were diagnosed as <i>H. pylori</i> positive, 907 were na&#239;ve with antibiogram available. Between 2015 and 2019, 1415 patients were diagnosed as <i>H. pylori</i> positive, antibiotic susceptibility test was available in 739 na&#239;ve patients. <i>H. pylori</i> primary antibiotic resistance rates in the first and second five-year period were, respectively, clarithromycin 30.2% (95% CI 27.2&#8722;33.3), 37.8% (95% CI 34.2&#8722;41.4); metronidazole 33.3% (95% CI 30.2&#8722;36.5), 33.6% (95% CI 30.2&#8722;37.1); levofloxacin 25.6% (95% CI 22.8&#8722;28.5), 33.8% (95% CI 37.4&#8722;47.4), double resistance clarithromycin-metronidazole 18.9% (95% CI 16.4&#8722;21.6), 20.7% (95% CI 17.8&#8722;23.8). The increase of the resistance rates to clarithromycin and levofloxacin in na&#239;ve patients was statistically significant (<i>p</i> &lt; 0.05). Although eradication rates for sequential therapy in the 10 years considered were 93.4% (95% CI 92&#8722;94.6) and 87.5% (95% CI 85.7&#8722;89) at per-protocol (PP) and intention-to-treat (ITT) analysis, respectively, they showed a significant decrease in the second five-year period. Conclusions: this data highlights an increase in primary <i>H. pylori</i> antibiotic resistance and strongly suggests the importance of drug susceptibility testing also in na&#239;ve patients.