Antimicrobial susceptibility testing for Helicobacter pylori in times of increasing antibiotic resistance

Abstract

The gram-negative bacterium Helicobacter pylori (H. pylori) causes chronic gastritis, gastric and duodenal ulcers, gastric cancer and mucosa-associated lymphoid tissue lymphoma. Treatment is recommended in all symptomatic patients. The current treatment options for H. pylori infection are outlined in this review in light of the recent challenges in eradication success, largely due to the rapid emergence of antibiotic resistant strains of H. pylori. Antibiotic resistance is a constantly evolving process and numerous studies have shown that the prevalence of H. pylori antibiotic resistance varies significantly from country to country, and even between regions within the same country. In addition, recent data has shown that previous antibiotic use is associated with harbouring antibiotic resistant H. pylori. Local surveillance of antibiotic resistance is warranted to guide clinicians in their choice of therapy. Antimicrobial resistance is assessed by H. pylori culture and antimicrobial susceptibility testing. Recently developed molecular tests offer an attractive alternative to culture and allow for the rapid molecular genetic identification of H. pylori and resistance-associated mutations directly from biopsy samples or bacterial culture material. Accumulating evidence indicates that surveillance of antimicrobial resistance by susceptibility testing is feasible and necessary to inform clinicians in their choice of therapy for management of H. pylori infection.

Keywords: Helicobacter pylori; Antibiotic resistance; Antimicrobial susceptibility testing; Polymerase chain reaction; Molecular test

Core tip: There has been a significant decrease in the success rate of empirical triple therapy to treat Helicobacter pylori (H. pylori) infection, largely due to a rapid increase in the prevalence of antibiotic resistant strains. Antibiotic resistance is a constantly evolving process and there are significant regional variations in H. pylori antibiotic resistance rates. As such, local surveillance of antibiotic resistance is warranted to guide clinicians in their therapeutic choice. Standard culture-based antimicrobial susceptibility testing and molecular methods provide key opportunities to tailor H. pylori treatment based on the detection of antibiotic resistant strains, thereby enhancing eradication rates and decreasing H. pylori-associated disease.