Jason Y Park1,2,3, Kerry B Dunbar4,5,6, Midori Mitui7, Christina A Arnold8, Dora M Lam-Himlin9, Mark A Valasek10, Irene Thung10, Chinemerem Okwara6, Elizabeth Coss5,6,11, Byron Cryer4,5,6, Christopher D Doern12. 1. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA. jason.park@childrens.com. 2. Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA. jason.park@childrens.com. 3. Department of Pathology, Children's Health Dallas, 1935 Medical District Drive, Dallas, TX, 75235, USA. jason.park@childrens.com. 4. Medical Service, Dallas Veterans Affairs Medical Center, Dallas, TX, USA. 5. Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 6. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. 7. Department of Pathology, Children's Health Dallas, 1935 Medical District Drive, Dallas, TX, 75235, USA. 8. Department of Pathology, Ohio State University Wexner Medical Center, Columbus, OH, USA. 9. Department of Pathology and Lab Medicine, Mayo Clinic, Arizona, Scottsdale, AZ, USA. 10. Division of Anatomic Pathology, Department of Pathology, University of California, San Diego, San Diego, CA, USA. 11. Texas Digestive Disease Consultants, Dallas, TX, USA. 12. Department of Pathology, Virginia Commonwealth University Health System, Richmond, VA, USA.
Abstract
BACKGROUND: Helicobacter pylori antibiotic resistance leads to frequent treatment failure. However, the current US prevalence of H. pylori clarithromycin resistance and treatment failure is unknown. AIMS: To determine the prevalence of clarithromycin-resistant H. pylori and its impact on treatment failure in the USA. METHODS: A multicenter, retrospective, cohort study for clarithromycin-resistant H. pylori was conducted over four academic medical centers in different geographic regions of the USA. Gastric biopsy material, residual from standard clinical pathologic examination, was examined for clarithromycin resistance by DNA sequencing of H. pylori 23S rRNA. RESULTS: One hundred and twenty-four cases of H. pylori gastritis were examined from medical centers in four different geographic regions of the USA. The overall prevalence of clarithromycin resistance was 32.3 % (range 23.1-45.8 %). There was no significant difference in the prevalence of clarithromycin resistance by study site, gender, age, or race/ethnicity. In a subset of 67 patients that had clinical follow-up data, the overall prevalence of clarithromycin resistance was 31.3 %. There was a 2.9-fold increase (p = 0.002) in treatment failure for cases with clarithromycin resistance (57.1 %) compared to wildtype H. pylori (19.6 %). CONCLUSIONS: H. pylori clarithromycin resistance in the USA exceeds the estimated 20 % prevalence compatible with successful empiric antibiotic therapy. This resistance resulted in a significant rate of treatment failure in all sites surveyed. Empiric therapy in the USA should be used with caution until there is better regional or local determination of H. pylori antibiotic resistance.
BACKGROUND:Helicobacter pylori antibiotic resistance leads to frequent treatment failure. However, the current US prevalence of H. pyloriclarithromycin resistance and treatment failure is unknown. AIMS: To determine the prevalence of clarithromycin-resistant H. pylori and its impact on treatment failure in the USA. METHODS: A multicenter, retrospective, cohort study for clarithromycin-resistant H. pylori was conducted over four academic medical centers in different geographic regions of the USA. Gastric biopsy material, residual from standard clinical pathologic examination, was examined for clarithromycin resistance by DNA sequencing of H. pylori 23S rRNA. RESULTS: One hundred and twenty-four cases of H. pylorigastritis were examined from medical centers in four different geographic regions of the USA. The overall prevalence of clarithromycin resistance was 32.3 % (range 23.1-45.8 %). There was no significant difference in the prevalence of clarithromycin resistance by study site, gender, age, or race/ethnicity. In a subset of 67 patients that had clinical follow-up data, the overall prevalence of clarithromycin resistance was 31.3 %. There was a 2.9-fold increase (p = 0.002) in treatment failure for cases with clarithromycin resistance (57.1 %) compared to wildtype H. pylori (19.6 %). CONCLUSIONS:H. pyloriclarithromycin resistance in the USA exceeds the estimated 20 % prevalence compatible with successful empiric antibiotic therapy. This resistance resulted in a significant rate of treatment failure in all sites surveyed. Empiric therapy in the USA should be used with caution until there is better regional or local determination of H. pylori antibiotic resistance.
Authors: Peter Malfertheiner; Francis Megraud; Colm A O'Morain; John Atherton; Anthony T R Axon; Franco Bazzoli; Gian Franco Gensini; Javier P Gisbert; David Y Graham; Theodore Rokkas; Emad M El-Omar; Ernst J Kuipers Journal: Gut Date: 2012-05 Impact factor: 23.059
Authors: Adrienne H Tveit; Michael G Bruce; Dana L Bruden; Julie Morris; Alisa Reasonover; Debby A Hurlburt; Thomas W Hennessy; Brian McMahon Journal: J Clin Microbiol Date: 2011-08-03 Impact factor: 5.948
Authors: B J Marshall; C S Goodwin; J R Warren; R Murray; E D Blincow; S J Blackbourn; M Phillips; T E Waters; C R Sanderson Journal: Lancet Date: 1988 Dec 24-31 Impact factor: 79.321
Authors: Francis Megraud; Samuel Coenen; Ann Versporten; Manfred Kist; Manuel Lopez-Brea; Alexander M Hirschl; Leif P Andersen; Herman Goossens; Youri Glupczynski Journal: Gut Date: 2012-05-12 Impact factor: 23.059
Authors: Stefan Jüttner; Michael Vieth; Stephan Miehlke; Wulf Schneider-Brachert; Christian Kirsch; Thilo Pfeuffer; Norbert Lehn; Manfred Stolte Journal: Mod Pathol Date: 2004-06 Impact factor: 7.842
Authors: Mohd Amer Alsamman; Eric C Vecchio; Khaled Shawwa; Gabriel Acosta-Gonzales; Murray B Resnick; Steven F Moss Journal: Dig Dis Sci Date: 2019-06-11 Impact factor: 3.199
Authors: Sarah Talarico; Andrew S Korson; Christina K Leverich; Stephanie Park; Florencia G Jalikis; Melissa P Upton; Elizabeth Broussard; Nina R Salama Journal: Helicobacter Date: 2018-02-26 Impact factor: 5.753
Authors: Skander Hathroubi; Stephanie L Servetas; Ian Windham; D Scott Merrell; Karen M Ottemann Journal: Microbiol Mol Biol Rev Date: 2018-05-09 Impact factor: 11.056
Authors: Pedro Cortés; Alfred D Nelson; Yan Bi; Fernando F Stancampiano; Loren P Murray; George G A Pujalte; Victoria Gomez; Dana M Harris Journal: J Prim Care Community Health Date: 2021 Jan-Dec