The influence of gastric atrophy on Helicobacter pylori antibiotics resistance in therapy-naïve patients.

Autor:	Goni E; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany., Tammer I; Otto-von-Guericke University Hospital, Institute of Medical Microbiology, Magdeburg, Germany., Schütte K; Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken, Marienhospital, Osnabrück, Germany.; Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Niedersachsen, Germany., Thon C; Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany., Jechorek D; Department of Pathology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany., Mahajan UM; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany., Vasapolli R; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.; Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Munich, München, Germany., Macke L; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.; Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Munich, München, Germany., Aulinger B; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany., Selgrad M; Department of Internal Medicine, Klinikum Fuerstenfeldbrueck, Fuerstenfeldbrueck, Germany.; Department of Internal Medicine I, University Hospital of Regensburg, Regensburg, Germany., Link A; Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Munich, München, Germany., Malfertheiner P; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.; Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany., Schulz C; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.; Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Munich, München, Germany.
Jazyk:	angličtina
Zdroj:	Frontiers in microbiology [Front Microbiol] 2022 Sep 23; Vol. 13, pp. 938676. Date of Electronic Publication: 2022 Sep 23 (Print Publication: 2022).
DOI:	10.3389/fmicb.2022.938676
Abstrakt:	Background: Antibiotic 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. Aim: To study the antibiotic resistance of H. pylori taking the severity of atrophic gastritis in antrum and corpus into account. Methods: Helicobacter 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. Results: Among 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. Conclusion: In 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. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Goni, Tammer, Schütte, Thon, Jechorek, Mahajan, Vasapolli, Macke, Aulinger, Selgrad, Link, Malfertheiner and Schulz.)
Databáze:	MEDLINE
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