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Dig Dis Sci. 2018 Feb;63(2):437-445. doi: 10.1007/s10620-017-4880-8. Epub 2017 Dec 20.

Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Salvage Therapy in the USA: A Real Life Experience.

Author information

1
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
2
Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, University of Michigan, 6520A MSRB1, SPC 5682, 1150 West Medical Center Drive, Ann Arbor, MI, 48109, USA.
3
Division of Gastroenterology, Department of Internal Medicine, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
4
Clinical Microbiology Laboratory, Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
5
Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, University of Michigan, 6520A MSRB1, SPC 5682, 1150 West Medical Center Drive, Ann Arbor, MI, 48109, USA. jykao@umich.edu.

Abstract

BACKGROUND:

The current practice guidelines recommend that Helicobacter pylori (H. pylori) culture and antimicrobial susceptibility testing (AST) be considered after patients failed the second course of H. pylori eradication therapy.

AIMS:

Here we report the real life experience of following this recommendation in the USA.

METHODS:

We established an in-house H. pylori culture protocol for AST and identified retrospectively patients who previously failed ≥ 2 courses of anti-H. pylori therapy and underwent esophagogastroduodenoscopy with AST at University of Michigan from 2010 to 2017. We determined the rate of H. pylori antibiotic resistance, the success rates of AST-guided tailored therapy, and the risk factors associated with treatment failure.

RESULTS:

Forty-seven patients were identified and 34 (72.3%) had successful cultures and AST. The most common antibiotic resistance was to metronidazole (79.4%), followed by clarithromycin (70.6%) and ciprofloxacin (42.9%). None of the patients were resistant to amoxicillin or tetracycline. The overall success rate of AST-guided tailored therapy was low (44.4%, 12/27). In patients infected with metronidazole-resistant H. pylori, bismuth quadruple therapy appears to be superior compared to non-bismuth quadruple therapy (6/8 or 75.0% vs. 3/14 or 21.4%, P = 0.03). High body mass index was significantly associated with tailored therapy failure (OR 1.24, 95% CI 1.00-1.54, P = 0.049).

CONCLUSIONS:

The success rate of AST-guided salvage therapy in the USA is low particularly in those with high BMI. Bismuth-based therapy appears to be better than non-bismuth-based regimens.

KEYWORDS:

Antibiotic resistance; Culture; Helicobacter pylori; Salvage therapy

PMID:
29264696
DOI:
10.1007/s10620-017-4880-8
[Indexed for MEDLINE]

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