Identification of antibiotic resistance patterns in Helicobacter pylori strains isolated from gastric biopsies using real-time PCR and genotypic analysis

Juanita Ann Spiteri; Graziella Zahra; John Schembri; Anthea Pisani; Elaine Borg; Neville Spiteri; Eliezer Zahra Bianco; Paul Caruana; James Gauci; Martina Muscat; Christopher Barbara; Pierre Ellul

Authors Juanita Ann Spiteri, Graziella Zahra, John Schembri, Anthea Pisani, Elaine Borg, Neville Spiteri, Eliezer Zahra Bianco, Paul Caruana, James Gauci, Martina Muscat, Christopher Barbara, Pierre Ellul.

Abstract

Background Helicobacter pylori (H. pylori) is associated with dyspepsia, mucus-associated lymphoid tissue lymphoma, gastritis, and peptic ulcer disease. Treatment in Malta consists of triple therapy, which consists of a proton pump inhibitor and 2 of the antibiotics amoxicillin, clarithromycin, metronidazole and fluoroquinolones. We aimed to determine the resistance rates for clarithromycin and fluoroquinolones in patients with H. pylori, and its incidence, in patients undergoing an esophagogastroduodenoscopy (EGD) using real-time polymerase chain reaction (RT-PCR).

Methods Patients undergoing an EGD were recruited. A rapid urease test (RUT) was performed, and 4 gastric biopsies were also taken (2 from antrum, 2 from corpus) and analyzed using RT-PCR. Positive samples were tested for antibiotic resistance using amplification and reverse hybridization techniques.

Results Two hundred patients (mean age 53.6 [range 20-92] years; 53.1% female) were recruited; the majority were (78%) non-smokers. H. pylori was identified in 21.0% of the patients. Fluoroquinolone resistance was detected in 21.4% of the patients. Clarithromycin resistance was observed in 26.2%, with dual resistance identified in 4.8% of the patients. A high concordance was present with patients testing negative for H. pylori with both RUT and RT-PCR (94.3%). Only 57.6% of patients tested positive with both tests. However, 92.9% of RT-PCR positive patients had a positive genotype HelicoDR test.

Conclusions This data demonstrates a high rate of H. pylori resistance to both clarithromycin and fluoroquinolones. These should be avoided when treating H. pylori by utilizing different treatment regimes. Furthermore, we derived important data on the role of RT-PCR, which may be implemented in routine clinical practice.

Keywords Helicobacter pylori, antibiotic resistance, clarithromycin, fluoroquinolones, genotype HelicoDR

Ann Gastroenterol 2021; 34 (4): 501-509