S1331 Antibiotic Resistance Rates in Helicobacter pylori Infection Derived from Retrospective Cure Rates

Abstract

INTRODUCTION: Current guidelines and consensus recommendations call for tailoring the treatment of Helicobacter pylori (H. pylori) to local antibiotic resistance patterns as resistance rates, particularly to clarithromycin, are increasing. However, knowledge of community resistance is uncommon because traditional culture and susceptibility testing is rarely performed. Thus, we aimed to evaluate susceptibility patterns based on eradication rates obtained from the electronic health record (EHR). METHODS: We performed a retrospective cohort study of all adult outpatients diagnosed with H. pylori at a single large tertiary care referral center between 6/1/2016 and 6/30/2018. Patient demographic data including age, sex, race, initial and confirmatory test modalities were extracted from the EHR. Factors associated with resistance were also collected, including clinic practice type, body mass index (BMI), history of diabetes, tobacco and alcohol use, prior antibiotic exposure, and H. pylori-directed antimicrobial regimens. Chi-square and Wilcoxon rank sum tests were used to assess associations between outcome and treatment regimen. RESULTS: There were 1,711 patients diagnosed with H. pylori during the study period and 622 (36%) underwent eradication testing. The cure rate among those with confirmatory testing was 90%, with stool antigen serving as the most common eradication test modality (N = 320, 51%). Comparing those with confirmed versus failed eradication, there were no significant differences by sex (P = 0.86), race (P = 0.44), or age (P = 0.16), respectively. Among treated patients, most (N = 392, 79%) received triple therapy and there was no significant difference in cure rates compared to those receiving quadruple therapy (P = 0.35). Additionally, the presence of clarithromycin in a regimen did not significantly affect eradication rates compared to those who received another regimen (90% versus 86%, respectively; P = 0.65). CONCLUSION: The H. pylori eradication rate among those tested was high, with no significant differences between studied regimens or evaluated factors. Importantly, clarithromycin resistance appears low within our local population. These findings indicate the feasibility of using data obtained from the EHR to track local H. pylori resistance patterns and highlight how knowledge of local antimicrobial resistance can guide therapy.Table 1.: Patient statistics by treatment outcomeFigure 1.: H. pylori eradication rates did not vary significantly (P = 0.65) by treatment regimen. The overall cure rate was 90% and clarithromycin-based regimens did not have a lower cure rate compared to other studied regimens. Abbr: Amox = amoxicillin, Clarith = clarithromycin, Tetra = tetracycline, Metro = metronidazole, PPI = proton pump inhibitor.