Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Salvage Therapy in the USA: A Real Life Experience
Journal
Digestive Diseases and Sciences
Journal Volume
63
Journal Issue
2
Pages
437-445
Date Issued
2018
Author(s)
Tan B.
Young C.L.
Bishu S.
Owyang S.Y.
El-Zaatari M.
Zhang M.
Grasberger H.
Qian J.-M.
Kao J.Y.
Abstract
Background: The current practice guidelines recommend that Helicobacter pylori (H. pylori) culture and antimicrobial susceptibility testing (AST) be considered after patients failed the second course of H. pylori eradication therapy. Aims: Here we report the real life experience of following this recommendation in the USA. Methods: We established an in-house H. pylori culture protocol for AST and identified retrospectively patients who previously failed ??2 courses of anti-H. pylori therapy and underwent esophagogastroduodenoscopy with AST at University of Michigan from 2010 to 2017. We determined the rate of H. pylori antibiotic resistance, the success rates of AST-guided tailored therapy, and the risk factors associated with treatment failure. Results: Forty-seven patients were identified and 34 (72.3%) had successful cultures and AST. The most common antibiotic resistance was to metronidazole (79.4%), followed by clarithromycin (70.6%) and ciprofloxacin (42.9%). None of the patients were resistant to amoxicillin or tetracycline. The overall success rate of AST-guided tailored therapy was low (44.4%, 12/27). In patients infected with metronidazole-resistant H. pylori, bismuth quadruple therapy appears to be superior compared to non-bismuth quadruple therapy (6/8 or 75.0% vs. 3/14 or 21.4%, P?=?0.03). High body mass index was significantly associated with tailored therapy failure (OR 1.24, 95% CI 1.00–1.54, P?=?0.049). Conclusions: The success rate of AST-guided salvage therapy in the USA is low particularly in those with high BMI. Bismuth-based therapy appears to be better than non-bismuth-based regimens. ? 2017, Springer Science+Business Media, LLC, part of Springer Nature.
Subjects
Antibiotic resistance; Culture; Helicobacter pylori; Salvage therapy
Other Subjects
amoxicillin; antibiotic agent; bismuth derivative; ciprofloxacin; clarithromycin; levofloxacin; metronidazole; proton pump inhibitor; rifabutin; tetracycline; antiinfective agent; bismuth; proton pump inhibitor; adult; antibiotic resistance; antibiotic sensitivity; antibiotic therapy; Article; bacterium culture; body mass; clinical article; combination drug therapy; drug megadose; drug treatment failure; eradication therapy; esophagogastroduodenoscopy; female; follow up; Helicobacter infection; Helicobacter pylori; human; human tissue; infection risk; male; middle aged; nonhuman; obesity; personal experience; polypharmacy; priority journal; retrospective study; salvage therapy; stomach biopsy; tetracycline resistance; United States; antibiotic resistance; drug effect; Helicobacter infection; Helicobacter pylori; microbiology; salvage therapy; treatment failure; Adult; Anti-Bacterial Agents; Bismuth; Drug Resistance, Bacterial; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Proton Pump Inhibitors; Salvage Therapy; Treatment Failure; United States
Publisher
Springer New York LLC
Type
journal article