Prevalence of Helicobacter pylori resistance to antibiotics in Northeast Italy: a multicentre study

Aims. To evaluate prevalence of primary Helicobacter pylori antibiotic resi stances in Northeast Italy and to identify risk factors associated with thi s resistance. Materials and methods. A total of 248 patients undergoing upper gastrointes tinal endoscopy were enrolled from 19 Endoscopy Units over a 6-month period . From each patient, 4 gastric biopsies were taken for histology and 2 were sent to the Central Referral Microbiological Laboratory for culture and de termination of antibiotic activity against Helicobacter pylori by means of E-test. Strains were considered resistant when minimum inhibitory concentra tion was >8 mug/ml for metronidazole and >1 mug/ml for clarithromycin. No c ut-off value was predefined for amoxycillin. Results. Culture of Helicobacter pylori was successfully performed in 167 p atients. Primary resistance to metronidazole, clarithromycin or amoxycillin was 14.9%, 1.8% and 0.%, respectively Patients infected with Helicobacter pylori strains resistant to antibiotics were more frequently females than m ales (70.3% vs 41.4%), had a significantly lower coffee intake (66.6% vs 86 .6%) and lower body mass index (23.7+/-2.6 vs 25.3+/-3.6) than patients wit h susceptible Helicobacter pylori strains. Age, smoking, alcohol use, famil y history of Helicobacter pylori infection, concomitant diseases and treatm ents, endoscopic diagnoses, Helicobacter pylori density and histological ac tivity of chronic gastritis were not associated with antibiotic resistance. Multivariate analysis confirmed that female gender (odds ratio = 2.74, 95% confidence interval = 1.03-7.27) was the only significant risk factor asso ciated with antibiotic resistance. Conclusions. in this population, primary Helicobacter pylori resistance to metronidazole was higher than resistance to clarithromycin, and female gend er was significantly associated with this resistance. The low prevalence of resistance to metronidazole, clarithromycin and amoxycillin identified in this geographical area suggests that proton pump inhibitor-based triple reg imens including these antibiotics may still be used as first line therapies against Helicobacter pylori infection.