- Email: [email protected]
Su1143 Trends in Secondary Antibiotic Resistance of Helicobacter Pylori 2007-2014-Has the Tide Turned?
AGA Abstracts
Compliance was 100% in both groups. The adverse event rates were 12.8% (10/78) and 24.6% (19/77) in the MOX-ST and CLA-ST group, respectively (P = 0.038). Most of the adverse events were mild-to-moderate in intensity; there was none serious enough to cause discontinuation of treatment in either group. In multivariate analysis, advanced age (≥ 60 years) was a significant independent factor related to the eradication failure in the CLA-ST group (adjusted odds ratio [OR]: 2.13, 95% confidence interval [CI]: 1.97-2.29, P = 0.004), whereas there was no significance in the MOX-ST group. Conclusions: The 14-day moxifloxacin-based sequential therapy is effective. Moreover, it shows excellent patient compliance and safety compared to the 14-day clarithromycin-based sequential therapy. Su1142 Prospective Serial Study on Primary Antibiotic Resistance of Helicobacter pylori Strains Isolated From Dyspeptic Patients Liya Zhou, Yuexi Zhang, Zhiqiang Song, Jianzhong Zhang, Lihua He BACKGROUND & AIMS: The updated information on antibiotic resistance by dynamic monitoring and serial detection is critical to the selection of the most optimal therapeutic regimens for eradication of Helicobacter pylori infection. This study was to determine the antibiotic resistance of Helicobacter pylori strains isolated from the dyspeptic patients in Beijing and monitor the change of antibiotic resistance over time. METHODS: In this prospective, single-centre, serial and observational study, Helicobacter pylori cultures were successfully obtained from 371 and 950 patients (never receiving eradication) during 20092010 and 2013-2014, respectively. Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline and rifampicin was determined by Epsilometer test according to the clinical resistance breakpoints for Helicobacter pylori proposed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). RESULTS: The resistance rates of isolates obtained during 2009-2010 were 66.8%, 39.9%, 34.5%, 15.4%, 6.7% and 4.9% for metronidazole, clarithromycin, levofloxacin, rifampicin, amoxicillin and tetracycline, respectively; and the same for isolates of 2013-2014 were 63.4%, 52.6%, 54.8%, 18.2%, 4.4% and 7.3%, respectively. The resistance rates for clarithromycin and levofloxacin were significantly increased after four years. In 2009-2010, 14.6% of Helicobacter pylori isolates were susceptible to all tested antibiotics followed by mono (33.7%), double (28.3%), triple (16.7%), quadruple (6.2%), quintuple (0.3%) and sextuple resistance (0.3%). In 2013-2014, 9.4% were all susceptible followed by mono (27.6%), double (28.4%), triple (24.9%), quadruple (7.3%), quintuple (2.3%) and sextuple resistance (0.1%). More multiple resistant Helicobacter pylori isolates were found during 2013-2014. Gender (to levofloxacin and metronidazole), age (to levofloxacin) and endoscopic finding (to clarithromycin) were the independent factors influencing antibiotic resistance. CONCLUSIONS: The resistance rates of Helicobacter pylori isolates to commonly used antibiotics in Beijing are strikingly high and the resistance to clarithromycin and levofloxacin rise quickly.
Figure 2. Comparisons of multiple antibiotic resistance rates between the two groups{BR}* P<0.05 Su1143 Trends in Secondary Antibiotic Resistance of Helicobacter Pylori 2007-2014Has the Tide Turned? Doron Boltin, Haim Ben Zvi, Tsachi T. Perets, Rachel Gingold-Belfer, Zmira Samra, Ram Dickman, Yaron Niv Background: Current guidelines recommend culture and antibiotic susceptibility testing of H. pylori following two failed eradication attempts. Where unavailable, epidemiological data for secondary H. pylori resistance are essential to allow for the rational use of antibiotics. The aim of this study was to describe the temporal changes in antibiotic resistance among adults previously treated for H. pylori, and to identify predictors of resistance. Methods: Between 2007 and 2014, consecutive patients undergoing gastroscopy with H. pylori culture and susceptibility testing at our institution following at least 2 treatment failures, were retrospectively identified. Antibiotic susceptibility was recorded and linked to demographic data. Results: 1042 patients were identified, including 739 (70.9%) males, aged 39.3±18.9 years. Resistance to clarithromycin, metronidazole and levofloxacin was found in 57.2%, 64.4% and 5.1% of isolates, respectively. Dual resistance to clarithromycin and metronidazole was seen in 39.9%. Over the study period, clarithromycin resistance increased annually in a linear manner (OR, 1.09; 95% CI, 1.03-1.14; p<0.01), levofloxacin resistance decreased annually (OR, 0.78; 95% CI, 0.61-0.92; p<0.01), and metronidazole resistance was nonlinear. Age was an independent predictor of resistance to all antibiotics. Time-elapsed predicted resistance for clarithromycin, levofloxacin and dual clarithromycin- metronidazole. Conclusion: Secondary resistance of H. pylori to clarithromycin and metronidazole remains high. Low secondary resistance to levofloxacin makes it an attractive treatment option in our region for patients following two failed eradication attempts.
Figure 1. Comparisons of overall antibiotic resistance rates between the two groups{BR}* P<0.05{BR}AMX, amoxicillin; CLA, clarithromycin; LEV, levofloxacin; MTZ, metronidazole; RIF, rifampicin; TET tetracycline.
Prevalence of Secondary Resistance of Helicobacter pylori in Israel, 2007- 2014.
S-419
AGA Abstracts
Compliance was 100% in both groups. The adverse event rates were 12.8% (10/78) and 24.6% (19/77) in the MOX-ST and CLA-ST group, respectively (P = 0.038). Most of the adverse events were mild-to-moderate in intensity; there was none serious enough to cause discontinuation of treatment in either group. In multivariate analysis, advanced age (≥ 60 years) was a significant independent factor related to the eradication failure in the CLA-ST group (adjusted odds ratio [OR]: 2.13, 95% confidence interval [CI]: 1.97-2.29, P = 0.004), whereas there was no significance in the MOX-ST group. Conclusions: The 14-day moxifloxacin-based sequential therapy is effective. Moreover, it shows excellent patient compliance and safety compared to the 14-day clarithromycin-based sequential therapy. Su1142 Prospective Serial Study on Primary Antibiotic Resistance of Helicobacter pylori Strains Isolated From Dyspeptic Patients Liya Zhou, Yuexi Zhang, Zhiqiang Song, Jianzhong Zhang, Lihua He BACKGROUND & AIMS: The updated information on antibiotic resistance by dynamic monitoring and serial detection is critical to the selection of the most optimal therapeutic regimens for eradication of Helicobacter pylori infection. This study was to determine the antibiotic resistance of Helicobacter pylori strains isolated from the dyspeptic patients in Beijing and monitor the change of antibiotic resistance over time. METHODS: In this prospective, single-centre, serial and observational study, Helicobacter pylori cultures were successfully obtained from 371 and 950 patients (never receiving eradication) during 20092010 and 2013-2014, respectively. Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline and rifampicin was determined by Epsilometer test according to the clinical resistance breakpoints for Helicobacter pylori proposed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). RESULTS: The resistance rates of isolates obtained during 2009-2010 were 66.8%, 39.9%, 34.5%, 15.4%, 6.7% and 4.9% for metronidazole, clarithromycin, levofloxacin, rifampicin, amoxicillin and tetracycline, respectively; and the same for isolates of 2013-2014 were 63.4%, 52.6%, 54.8%, 18.2%, 4.4% and 7.3%, respectively. The resistance rates for clarithromycin and levofloxacin were significantly increased after four years. In 2009-2010, 14.6% of Helicobacter pylori isolates were susceptible to all tested antibiotics followed by mono (33.7%), double (28.3%), triple (16.7%), quadruple (6.2%), quintuple (0.3%) and sextuple resistance (0.3%). In 2013-2014, 9.4% were all susceptible followed by mono (27.6%), double (28.4%), triple (24.9%), quadruple (7.3%), quintuple (2.3%) and sextuple resistance (0.1%). More multiple resistant Helicobacter pylori isolates were found during 2013-2014. Gender (to levofloxacin and metronidazole), age (to levofloxacin) and endoscopic finding (to clarithromycin) were the independent factors influencing antibiotic resistance. CONCLUSIONS: The resistance rates of Helicobacter pylori isolates to commonly used antibiotics in Beijing are strikingly high and the resistance to clarithromycin and levofloxacin rise quickly.
Figure 2. Comparisons of multiple antibiotic resistance rates between the two groups{BR}* P<0.05 Su1143 Trends in Secondary Antibiotic Resistance of Helicobacter Pylori 2007-2014Has the Tide Turned? Doron Boltin, Haim Ben Zvi, Tsachi T. Perets, Rachel Gingold-Belfer, Zmira Samra, Ram Dickman, Yaron Niv Background: Current guidelines recommend culture and antibiotic susceptibility testing of H. pylori following two failed eradication attempts. Where unavailable, epidemiological data for secondary H. pylori resistance are essential to allow for the rational use of antibiotics. The aim of this study was to describe the temporal changes in antibiotic resistance among adults previously treated for H. pylori, and to identify predictors of resistance. Methods: Between 2007 and 2014, consecutive patients undergoing gastroscopy with H. pylori culture and susceptibility testing at our institution following at least 2 treatment failures, were retrospectively identified. Antibiotic susceptibility was recorded and linked to demographic data. Results: 1042 patients were identified, including 739 (70.9%) males, aged 39.3±18.9 years. Resistance to clarithromycin, metronidazole and levofloxacin was found in 57.2%, 64.4% and 5.1% of isolates, respectively. Dual resistance to clarithromycin and metronidazole was seen in 39.9%. Over the study period, clarithromycin resistance increased annually in a linear manner (OR, 1.09; 95% CI, 1.03-1.14; p<0.01), levofloxacin resistance decreased annually (OR, 0.78; 95% CI, 0.61-0.92; p<0.01), and metronidazole resistance was nonlinear. Age was an independent predictor of resistance to all antibiotics. Time-elapsed predicted resistance for clarithromycin, levofloxacin and dual clarithromycin- metronidazole. Conclusion: Secondary resistance of H. pylori to clarithromycin and metronidazole remains high. Low secondary resistance to levofloxacin makes it an attractive treatment option in our region for patients following two failed eradication attempts.
Figure 1. Comparisons of overall antibiotic resistance rates between the two groups{BR}* P<0.05{BR}AMX, amoxicillin; CLA, clarithromycin; LEV, levofloxacin; MTZ, metronidazole; RIF, rifampicin; TET tetracycline.
Prevalence of Secondary Resistance of Helicobacter pylori in Israel, 2007- 2014.
S-419
AGA Abstracts