Antibiotic resistance patterns and therapeutic outcomes of pediatric Helicobacter pylori infection in a high-migrant Singaporean cohort

Factors associated with Helicobacter pylori antimicrobial resistance in a US pediatric cohort

OBJECTIVES

The rising rates of Helicobacter pylori antimicrobial resistance highlight the importance of better understanding its epidemiology in the pediatric population. We aim to study the epidemiological factors associated with antimicrobial resistance in a cohort of US children with H. pylori infection.

METHODS

A retrospective cohort study of patients in the New England region of the United States between January 15, 2015 and October 15, 2022, with a first-time diagnosis of H. pylori on gastric biopsy and who had antimicrobial resistance data available. Descriptive statistics and logistic regression models were used to determine associations between the patient's demographics, clinical factors, endoscopic findings, and antimicrobial resistance.

RESULTS

Out of 273 patients (46% male, median 12.8 years), 118 (43.2%) were resistant to at least one antimicrobial. Clarithromycin resistance (24.5%) was the highest, followed by metronidazole (21.6%), fluoroquinolones (9.9%), rifabutin (3.3%), and amoxicillin (2.6%). Clarithromycin resistance was higher in Asians compared to White individuals (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [2.01-10.89], p < 0.001), and lower in Black compared to White individuals (OR: 0.23, 95% CI: [0.08-0.69], p = 0.01). Antimicrobial resistance to clarithromycin and metronidazole were similar among Hispanics. Asian individuals were more likely to demonstrate one or more antimicrobial resistances compared to White (OR: 3.66, 95% CI: [1.50-8.89], p < 0.001). Compared to individuals from higher household incomes (>$100,000), those from less than $30,000 household incomes had a higher risk of metronidazole resistance (OR: 7.94, 95% CI: [1.83-34.36], p = 0.01).

CONCLUSION

Our study provides novel information concerning the association of H. pylori antimicrobial resistance to race, socioeconomic status, and age in the pediatric population.

Global prevalence of Helicobacter pylori antibiotic resistance among children in the world health organization regions between 2000 and 2023: a systematic review and meta-analysis

BACKGROUND

Helicobacter pylori infection causes gastritis, peptic ulcers, and gastric cancer. The infection is typically acquired in childhood and persists throughout life. The major impediment to successful therapy is antibiotic resistance. This systematic review and meta-analysis aimed to comprehensively assess the global prevalence of antibiotic resistance in pediatric H. pylori infection.

METHODS

We performed a systematic search of publication databases that assessed H. pylori resistance rates to clarithromycin, metronidazole, levofloxacin, amoxicillin, and tetracycline in children. The WHO region classification was used to group pooled primary and secondary resistance estimates along with 95% confidence interval (CI). H. pylori antibiotic resistance rates were retrieved and combined with odds ratios (95% CI) to investigate the global prevalence and temporal trends. Subgroup analysis of the prevalence of antibiotic resistance was conducted by country, age groups, and susceptibility testing methods.

RESULTS

Among 1417 records obtained initially, 152 studies were selected for eligibility assessment after applying exclusion criteria in multiple steps. Ultimately, 63 studies involving 15,953 individuals were included comprising data from 28 countries in 5 WHO regions. The primary resistance rates were metronidazole 35.3% (5482/15,529, 95% CI: 28.7-42.6), clarithromycin 32.6% (5071/15,555, 95% CI: 27.7-37.9), tetracycline 2.1% (148/7033, 95% CI: 1.3-3.6), levofloxacin 13.2% (1091/8271, 95% CI: 9.3-18.4), and amoxicillin 4.8% (495/10305, 95% CI: 2.5-8.8). Raising antibiotic resistance was detected in most WHO regions.

CONCLUSIONS

The escalating trend of H. pylori antibiotic resistance in children warrants urgent attention globally. National and regional surveillance networks are required for antibiotic stewardship in children infected with H. pylori.

Prevalence, Management, and Outcomes of Non-Invasive Helicobacter pylori Testing in Children at a Tertiary Paediatric Hospital in Singapore

Purpose

Helicobacter pylori infections differ between children and adults. The Pediatric society practice guidelines recommend against a test-and-treat approach, characterized by the use of non-invasive tests for diagnosis (e.g. urea breath test [UBT] or stool antigen test). However, significant variations exist in clinical practice. This study examined the use of non-invasive testing for the screening and diagnosis of H. pylori infection in children at a tertiary pediatric hospital in Singapore, reviewing both management decisions and patient outcomes.

Methods

A retrospective review was conducted on children between the ages of 0 and 18 years who were tested for H. pylori infection using either a stool antigen test or UBT between January 2018 and June 2020.

Results

Among the 1,397 children tested, 117 (8.4%) had a positive stool H. pylori antigen result, and 5 out of 85 tested (5.9%) had a positive UBT. Abdominal pain was the predominant symptom (n=98; 80.3%). Only 7 treatment-naïve children had biopsy-proven disease. Tissue biopsies for H. pylori culture were sent to 2 children, with 1 negative result. A total of 111 children (91.0%) received treatment, wherein proton pump inhibitor, amoxicillin, and clarithromycin for 14 days was the most common therapeutic regimen. Symptom resolution was observed in 62 children (50.8%).

Conclusion

A test-and-treat strategy was more widely utilized than endoscopy-based testing, showing a low compliance to existing guidelines for the management of H. pylori infections in children at our center and significant false-positive rates.

Success of susceptibility-guided eradication of Helicobacter pylori in a region with high secondary clarithromycin and levofloxacin resistance rates

BACKGROUND

Resistance to clarithromycin (CLA) and levofloxacin (LFX) of Helicobacter pylori (H. pylori) is increasing in severity, and successful eradication is essential. Presently, the eradication success rate has greatly declined, leaving a large number of patients with previous treatment histories.

AIM

To investigate secondary resistance rates, explore risk factors for antibiotic resistance, and assess the efficacy of susceptibility-guided therapy.

METHODS

We recruited 154 subjects positive for Urea Breath Test who attended The First Affiliated Hospital of China Medical University between July 2022 and April 2023. Participants underwent a string test after an overnight fast. The gastric juice was obtained and transferred to vials containing storage solution. Subsequently, DNA extraction and the specific DNA amplification were performed using quantitative polymerase chain reaction (qPCR). Demographic information was also analyzed as part of the study. Based on these results, the participants were administered susceptibility-guided treatment. Efficacy was compared with that of the empiric treatment group.

RESULTS

A total of 132 individuals tested positive for the H. pylori ureA gene by qPCR technique. CLA resistance rate reached a high level of 82.6% (n = 109), LFX resistance rate was 69.7% (n = 92) and dual resistance was 62.1% (n = 82). Gastric symptoms [odds ratio (OR) = 2.782; 95% confidence interval (95%CI): 1.076-7.194; P = 0.035] and rural residence (OR = 5.152; 95%CI: 1.407-18.861; P = 0.013) were independent risk factors for secondary resistance to CLA and LFX, respectively. A total of 102 and 100 individuals received susceptibility-guided therapies and empiric treatment, respectively. The antibiotic susceptibility-guided treatment and empiric treatment groups achieved successful eradication rates of 75.5% (77/102) and 59.0% (59/411) by the intention-to-treat (ITT) analysis and 90.6% (77/85) and 70.2% (59/84) by the per-protocol (PP) analysis, respectively. The eradication rates of these two treatment strategies were significantly different in both ITT (P = 0.001) and PP (P = 0.012) analyses.

CONCLUSION

H. pylori presented high secondary resistance rates to CLA and LFX. For patients with previous treatment failures, treatments should be guided by antibiotic susceptibility tests or regional antibiotic resistance profile.

Prevalence of Primary Multidrug-resistant Helicobacter pylori in Children: A Systematic Review and Meta-analysis

BACKGROUND

The emergence and global spread of multidrug-resistant Helicobacter pylori (MDR H. pylori) is a major health problem in children, which can increase the risk of serious complications such as gastric cancer. The aim of this study was to determine the prevalence of primary MDR H. pylori in children via a comprehensive systematic literature review and meta-analysis.

METHODS

All potential studies were collected from international databases like: ISI Web of Science, Embase, PubMed, Google Scholar, and Scopus from 2011-July 24, 2022. Ultimately, primary MDR H. pylori in children was measured as an event rate with corresponding 95% confidence intervals.

RESULTS

A total of 19 studies met the inclusion criteria. The overall prevalence of primary MDR H. pylori in children was measured at 6.0% (95% CI: 3.1-11.6); There was a significant difference in primary MDR H. pylori resistance rates between Asian populations and Western countries.

CONCLUSIONS

The global spread of MDR H. pylori strains could significantly limit the options of anti-H. pylori treatment regimens. The frequency of primary MDR H. pylori infection differs between various geographical regions. Thus, drug susceptibility testing and the eradication of H. pylori infection can effectively reduce and control the spread of H. pylori antibiotic resistance throughout the world.