The influence of gastric atrophy on Helicobacter pylori antibiotics resistance in therapy-naïve patients
BackgroundAntibiotic susceptibility of Helicobacter pylori to antibiotics may vary among different niches of the stomach. The progression of chronic H. pylori gastritis to atrophy changes intragastric physiology that may influence selection of resistant strains.AimTo study the antibiotic resistance...
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| Format: | Article |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Microbiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmicb.2022.938676/full |
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| author | Elisabetta Goni Ina Tammer Kerstin Schütte Kerstin Schütte Cosima Thon Dörthe Jechorek Ujjwal Mukund Mahajan Riccardo Vasapolli Riccardo Vasapolli Lukas Macke Lukas Macke Benedikt Aulinger Michael Selgrad Michael Selgrad Alexander Link Peter Malfertheiner Peter Malfertheiner Christian Schulz Christian Schulz |
| author_facet | Elisabetta Goni Ina Tammer Kerstin Schütte Kerstin Schütte Cosima Thon Dörthe Jechorek Ujjwal Mukund Mahajan Riccardo Vasapolli Riccardo Vasapolli Lukas Macke Lukas Macke Benedikt Aulinger Michael Selgrad Michael Selgrad Alexander Link Peter Malfertheiner Peter Malfertheiner Christian Schulz Christian Schulz |
| author_sort | Elisabetta Goni |
| collection | DOAJ |
| description | BackgroundAntibiotic susceptibility of Helicobacter pylori to antibiotics may vary among different niches of the stomach. The progression of chronic H. pylori gastritis to atrophy changes intragastric physiology that may influence selection of resistant strains.AimTo study the antibiotic resistance of H. pylori taking the severity of atrophic gastritis in antrum and corpus into account.MethodsHelicobacter pylori-positive patients (n = 110, m = 32, mean age 52.6 ± 13.9 years) without prior H. pylori eradication undergoing upper gastrointestinal (GI) endoscopy for dyspeptic symptoms were included in a prospective study. Patients were stratified into three groups depending on the grade of atrophy: no atrophy (OLGA Stage 0), mild atrophy (OLGA Stage I–II) and moderate/severe atrophy (OLGA Stage III–IV). Two biopsies each from the antrum and the corpus and one from the angulus were taken and assessed according to the updated Sydney system. H. pylori strains were isolated from antrum and corpus biopsies and tested for antibiotic susceptibility (AST) for amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin by the agar dilution methods. A Chi-square test of independence with a 95% confidence interval was used to detect differences in the proportion of patients with susceptible and resistant H. pylori strains.ResultsAmong 110 patients, primary clarithromycin resistance (R) was 30.0%, both in the antrum and corpus; metronidazole resistance accounted for 36.4 and 34.5% in the antrum and corpus; and levofloxacin was 19.1 and 22.7% in the antrum and corpus, respectively. Resistance rates to amoxicillin, tetracycline, and rifampicin were below 5%. Dual antibiotic resistance rate was 21.8%, and triple resistance rate was 9.1%. There was a significant difference in the resistance rate distribution in antrum (p < 0.0001) and corpus (p < 0.0001). With increasing severity of atrophy according to OLGA stages, there was a significant increase in clarithromycin-R and metronidazole-R.ConclusionIn treatment-naïve patients, antibiotic resistance and heteroresistance were related to the severity of atrophy. The high clarithromycin resistance in atrophic gastritis suggests that H. pylori antibiotic susceptibility testing should always be performed in this condition before selecting the eradication regimen. |
| first_indexed | 2024-04-12T04:33:59Z |
| format | Article |
| id | doaj.art-e157ffa91bc440b3aa38acfe0386a5b6 |
| institution | Directory Open Access Journal |
| issn | 1664-302X |
| language | English |
| last_indexed | 2024-04-12T04:33:59Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Microbiology |
| spelling | doaj.art-e157ffa91bc440b3aa38acfe0386a5b62022-12-22T03:47:51ZengFrontiers Media S.A.Frontiers in Microbiology1664-302X2022-09-011310.3389/fmicb.2022.938676938676The influence of gastric atrophy on Helicobacter pylori antibiotics resistance in therapy-naïve patientsElisabetta Goni0Ina Tammer1Kerstin Schütte2Kerstin Schütte3Cosima Thon4Dörthe Jechorek5Ujjwal Mukund Mahajan6Riccardo Vasapolli7Riccardo Vasapolli8Lukas Macke9Lukas Macke10Benedikt Aulinger11Michael Selgrad12Michael Selgrad13Alexander Link14Peter Malfertheiner15Peter Malfertheiner16Christian Schulz17Christian Schulz18Department of Medicine II, University Hospital, LMU Munich, Munich, GermanyOtto-von-Guericke University Hospital, Institute of Medical Microbiology, Magdeburg, GermanyDepartment of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken, Marienhospital, Osnabrück, GermanyDepartment of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Niedersachsen, GermanyDepartment of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, GermanyDepartment of Pathology, Otto-von-Guericke-University Magdeburg, Magdeburg, GermanyDepartment of Medicine II, University Hospital, LMU Munich, Munich, GermanyDepartment of Medicine II, University Hospital, LMU Munich, Munich, GermanyDeutsches Zentrum für Infektionsforschung (DZIF), Partner Site Munich, München, GermanyDepartment of Medicine II, University Hospital, LMU Munich, Munich, GermanyDeutsches Zentrum für Infektionsforschung (DZIF), Partner Site Munich, München, GermanyDepartment of Medicine II, University Hospital, LMU Munich, Munich, GermanyDepartment of Internal Medicine, Klinikum Fuerstenfeldbrueck, Fuerstenfeldbrueck, GermanyDepartment of Internal Medicine I, University Hospital of Regensburg, Regensburg, GermanyDeutsches Zentrum für Infektionsforschung (DZIF), Partner Site Munich, München, GermanyDepartment of Medicine II, University Hospital, LMU Munich, Munich, GermanyDepartment of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, GermanyDepartment of Medicine II, University Hospital, LMU Munich, Munich, GermanyDeutsches Zentrum für Infektionsforschung (DZIF), Partner Site Munich, München, GermanyBackgroundAntibiotic susceptibility of Helicobacter pylori to antibiotics may vary among different niches of the stomach. The progression of chronic H. pylori gastritis to atrophy changes intragastric physiology that may influence selection of resistant strains.AimTo study the antibiotic resistance of H. pylori taking the severity of atrophic gastritis in antrum and corpus into account.MethodsHelicobacter pylori-positive patients (n = 110, m = 32, mean age 52.6 ± 13.9 years) without prior H. pylori eradication undergoing upper gastrointestinal (GI) endoscopy for dyspeptic symptoms were included in a prospective study. Patients were stratified into three groups depending on the grade of atrophy: no atrophy (OLGA Stage 0), mild atrophy (OLGA Stage I–II) and moderate/severe atrophy (OLGA Stage III–IV). Two biopsies each from the antrum and the corpus and one from the angulus were taken and assessed according to the updated Sydney system. H. pylori strains were isolated from antrum and corpus biopsies and tested for antibiotic susceptibility (AST) for amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin by the agar dilution methods. A Chi-square test of independence with a 95% confidence interval was used to detect differences in the proportion of patients with susceptible and resistant H. pylori strains.ResultsAmong 110 patients, primary clarithromycin resistance (R) was 30.0%, both in the antrum and corpus; metronidazole resistance accounted for 36.4 and 34.5% in the antrum and corpus; and levofloxacin was 19.1 and 22.7% in the antrum and corpus, respectively. Resistance rates to amoxicillin, tetracycline, and rifampicin were below 5%. Dual antibiotic resistance rate was 21.8%, and triple resistance rate was 9.1%. There was a significant difference in the resistance rate distribution in antrum (p < 0.0001) and corpus (p < 0.0001). With increasing severity of atrophy according to OLGA stages, there was a significant increase in clarithromycin-R and metronidazole-R.ConclusionIn treatment-naïve patients, antibiotic resistance and heteroresistance were related to the severity of atrophy. The high clarithromycin resistance in atrophic gastritis suggests that H. pylori antibiotic susceptibility testing should always be performed in this condition before selecting the eradication regimen.https://www.frontiersin.org/articles/10.3389/fmicb.2022.938676/fullantibiotic resistance rateantibiotic susceptibility testingantibiotic stewardshipupdated treatment strategiesHelicobacter pylori infectionchronic atrophic gastritis |
| spellingShingle | Elisabetta Goni Ina Tammer Kerstin Schütte Kerstin Schütte Cosima Thon Dörthe Jechorek Ujjwal Mukund Mahajan Riccardo Vasapolli Riccardo Vasapolli Lukas Macke Lukas Macke Benedikt Aulinger Michael Selgrad Michael Selgrad Alexander Link Peter Malfertheiner Peter Malfertheiner Christian Schulz Christian Schulz The influence of gastric atrophy on Helicobacter pylori antibiotics resistance in therapy-naïve patients Frontiers in Microbiology antibiotic resistance rate antibiotic susceptibility testing antibiotic stewardship updated treatment strategies Helicobacter pylori infection chronic atrophic gastritis |
| title | The influence of gastric atrophy on Helicobacter pylori antibiotics resistance in therapy-naïve patients |
| title_full | The influence of gastric atrophy on Helicobacter pylori antibiotics resistance in therapy-naïve patients |
| title_fullStr | The influence of gastric atrophy on Helicobacter pylori antibiotics resistance in therapy-naïve patients |
| title_full_unstemmed | The influence of gastric atrophy on Helicobacter pylori antibiotics resistance in therapy-naïve patients |
| title_short | The influence of gastric atrophy on Helicobacter pylori antibiotics resistance in therapy-naïve patients |
| title_sort | influence of gastric atrophy on helicobacter pylori antibiotics resistance in therapy naive patients |
| topic | antibiotic resistance rate antibiotic susceptibility testing antibiotic stewardship updated treatment strategies Helicobacter pylori infection chronic atrophic gastritis |
| url | https://www.frontiersin.org/articles/10.3389/fmicb.2022.938676/full |
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