C Bilgilier1, A Stadlmann1, A Makristathis2, J Thannesberger1, M-T Kastner1, P Knoflach3, P Steiner3, M Schöniger-Hekele4, C Högenauer5, A Blesl5, C Datz6, U Huber-Schönauer6, R Schöfl7, F Wewalka7, A Püspök8, N Mitrovits8, J Leiner9, H Tilg10, M Effenberger10, M Moser11, F Siebert12, I Hinterberger12, H Wurzer13, T Stupnicki13, N Watzinger14, G Gombotz14, R Hubmann15, S Klimpel16, S Biowski-Frotz17, C Schrutka-Kölbl18, I Graziadei19, O Ludwiczek19, M Kundi20, A M Hirschl2, C Steininger21. 1. Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria. 2. Department of Laboratory Medicine, Division of Clinical Microbiology, Austria. 3. Department of Internal Medicine I, Klinikum Wels-Grieskirchen, Wels, Austria. 4. Department of Medicine III, Division of Gastroenterology and Hepatology, Austria. 5. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria. 6. Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private Medical University Salzburg, Oberndorf bei Salzburg, Austria. 7. Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, Ordensklinikum Linz, Elisabethinen, Austria. 8. Department of Internal Medicine II, Hospital of the Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria. 9. Department of Internal Medicine, Ladislaus Batthyány-Strattmann Hospital Kittsee, Kittsee, Austria. 10. Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria. 11. Ordination Dr Moser, Hall/Tyrol, Austria. 12. Department of Internal Medicine, Hospital of the Brothers of Saint John of God St Veit/Glan, St Veit, Austria. 13. Department of Internal Medicine, LKH Graz South-West, Graz, Austria. 14. Department of Internal Medicine, Hospital Group Feldbach-Fürstenfeld, Feldbach, Austria. 15. Ordination Dr Rainer Hubmann, Linz, Austria. 16. Ordination Dr Siegfried Klimpel, Traun, Austria. 17. Ordination Dr Susanne Biowski-Frotz, Vienna, Austria. 18. Endoskopie Schrutka, Vienna, Austria. 19. Department of Internal Medicine, Academic Teaching Hospital, Hall/Tyrol, Austria. 20. Department of Environmental Health, Center for Public Health, Medical University of Vienna, Austria. 21. Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria. Electronic address: christoph.steininger@meduniwien.ac.at.
Abstract
OBJECTIVES: We report on a large prospective, multicentre clinical investigation on inter- and intrapatient genetic variability for antimicrobial resistance of Helicobacter pylori. METHODS: Therapy-naive patients (n = 2004) who had undergone routine diagnostic gastroscopy were prospectively included from all geographic regions of Austria. Gastric biopsy samples were collected separately from antrum and corpus. Samples were analysed by histopathology and real-time PCR for genotypic resistance to clarithromycin and quinolones. Clinical and demographic information was analysed in relation to resistance patterns. RESULTS: H. pylori infection was detected in 514 (26%) of 2004 patients by histopathology and confirmed in 465 (90%) of 514 patients by real-time PCR. PCR results were discordant for antrum and corpus in 27 (5%) of 514 patients, indicating inhomogeneous infections. Clarithromycin resistance rates were 17% (77/448) and 19% (84/455), and quinolone resistance rates were 12% (37/310) and 10% (32/334) in antrum and corpus samples, respectively. Combination of test results per patient yielded resistance rates of 21% (98/465) and 13% (50/383) for clarithromycin and quinolones, respectively. Overall, infection with both sensitive and resistant H. pylori was detected in 65 (14%) of 465 patients. CONCLUSIONS: Anatomically inhomogeneous infection with different, multiple H. pylori strains is common. Prospective clinical study design, collection of samples from multiple sites and microbiologic methods that allow the detection of coinfections are mandatory for collection of reliable data on antimicrobial resistance patterns in representative patient populations. (ClinicalTrials.gov identifier: NCT02925091).
OBJECTIVES: We report on a large prospective, multicentre clinical investigation on inter- and intrapatient genetic variability for antimicrobial resistance of Helicobacter pylori. METHODS: Therapy-naive patients (n = 2004) who had undergone routine diagnostic gastroscopy were prospectively included from all geographic regions of Austria. Gastric biopsy samples were collected separately from antrum and corpus. Samples were analysed by histopathology and real-time PCR for genotypic resistance to clarithromycin and quinolones. Clinical and demographic information was analysed in relation to resistance patterns. RESULTS: H. pylori infection was detected in 514 (26%) of 2004 patients by histopathology and confirmed in 465 (90%) of 514 patients by real-time PCR. PCR results were discordant for antrum and corpus in 27 (5%) of 514 patients, indicating inhomogeneous infections. Clarithromycin resistance rates were 17% (77/448) and 19% (84/455), and quinolone resistance rates were 12% (37/310) and 10% (32/334) in antrum and corpus samples, respectively. Combination of test results per patient yielded resistance rates of 21% (98/465) and 13% (50/383) for clarithromycin and quinolones, respectively. Overall, infection with both sensitive and resistant H. pylori was detected in 65 (14%) of 465 patients. CONCLUSIONS: Anatomically inhomogeneous infection with different, multiple H. pylori strains is common. Prospective clinical study design, collection of samples from multiple sites and microbiologic methods that allow the detection of coinfections are mandatory for collection of reliable data on antimicrobial resistance patterns in representative patient populations. (ClinicalTrials.gov identifier: NCT02925091).
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