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Insights into Helicobacter pylori macrolide resistance: a comprehensive systematic review and meta-analysis
Safoura Morad Kasani1, Maryam Mofid2, Tahereh Navidifar3
1Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran.
Background:
Helicobacter pylori infection is a primary global health concern. However, the widespread use of antibiotics, particularly macrolides such as clarithromycin, has increased resistance among H. pylori strains. This study aimed to investigate the prevalence of macrolide resistance in H. pylori in different world regions.
Methods:
This systematic literature search was performed using the appropriate search syntax after searching PubMed, Embase, Web of Science, and Scopus databases between May 2015 and December 2023. Statistical analysis was performed using Pooled and random effects model in R and the metafor package.
Results:
A total of 7,768 articles were retrieved. After a thorough evaluation, 155 studies (by 178 reports) were finally eligible for inclusion in this systematic review and meta-analysis. According to the results, the majority of studies (178 reports from 43 countries) assessed clarithromycin susceptibility, with a pooled prevalence of 33.3% and high heterogeneity between studies (I 2 = 98.57%, p < 0.001). The rate of erythromycin resistance was moderate (22.8%, 10 reports), while azithromycin resistance was 34.4% (4 reports). Subgroup analysis revealed significant differences in the prevalence of resistance based on geographic location, continent, and year of publication. Clarithromycin resistance increased from 29.1% (2015-2019) to 36.5% (2020-2023).
Conclusion:
This study highlights the critical challenges of macrolide resistance in treating H. pylori infection. The high prevalence and geographic variation underscore the need for tailored treatment strategies based on regional resistance patterns. Furthermore, continuously monitoring resistance trends and investigating contributing factors are essential to optimize treatment.
Systematic Review Registration:
https://www.crd.york.ac.uk/prospero; CRD42024557749.
Insights
Macrolide resistance in Helicobacter pylori is a growing concern, with clarithromycin resistance at 33.3%. This global issue necessitates region-specific treatment strategies to combat rising H. pylori resistance.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Helicobacter pylori infection is a significant global health challenge.
- Increasing antibiotic resistance, particularly to macrolides like clarithromycin, complicates H. pylori treatment.
- There is a need to understand the geographic distribution of macrolide resistance in H. pylori.
Purpose of the Study:
- To investigate the global prevalence of macrolide resistance in Helicobacter pylori strains.
- To analyze variations in resistance patterns across different world regions.
- To provide data supporting the development of targeted H. pylori treatment strategies.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, Web of Science, Scopus) from May 2015 to December 2023.
- Meta-analysis and pooled random effects models were employed for statistical analysis.
- Included 155 studies (178 reports) from 43 countries, focusing on clarithromycin, erythromycin, and azithromycin resistance.
Main Results:
- The pooled prevalence of clarithromycin resistance was 33.3%, with significant heterogeneity (I²=98.57%).
- Erythromycin resistance was 22.8% and azithromycin resistance was 34.4%.
- Clarithromycin resistance showed an increasing trend, rising from 29.1% (2015-2019) to 36.5% (2020-2023), with significant geographic variations.
Conclusions:
- Macrolide resistance poses a critical challenge for H. pylori infection treatment.
- Geographic variations in resistance highlight the need for tailored, region-specific therapeutic approaches.
- Continuous monitoring of resistance trends and contributing factors is crucial for optimizing H. pylori treatment efficacy.
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