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Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Factors associated with Helicobacter pylori antimicrobial resistance in a US pediatric cohort
Muhammad Riaz1, Christina Chan2, Christine Andrews3
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Oklahoma, Oklahoma City, Oklahoma, USA.
Insights
Helicobacter pylori antimicrobial resistance is common in US children, with significant associations found between resistance patterns and race, socioeconomic status, and age. Asian children showed higher resistance rates, while lower income correlated with metronidazole resistance.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Epidemiology
Background:
- Rising antimicrobial resistance in Helicobacter pylori (H. pylori) necessitates understanding its epidemiology in children.
- Pediatric H. pylori infections require effective treatment strategies, which are challenged by increasing resistance rates.
Purpose of the Study:
- To investigate epidemiological factors associated with H. pylori antimicrobial resistance in a US pediatric cohort.
- To identify demographic and clinical correlations with H. pylori resistance patterns in children.
Main Methods:
- Retrospective cohort study of 273 pediatric patients diagnosed with H. pylori infection between 2015 and 2022 in the New England region.
- Analysis included descriptive statistics and logistic regression to assess associations between patient demographics, clinical factors, and antimicrobial resistance data.
Main Results:
- Over 43% of pediatric patients exhibited resistance to at least one antimicrobial, with clarithromycin (24.5%) and metronidazole (21.6%) resistance being most prevalent.
- Asian children had significantly higher rates of clarithromycin and overall antimicrobial resistance compared to White children.
- Lower socioeconomic status (household income <$30,000) was associated with increased risk of metronidazole resistance.
Conclusions:
- H. pylori antimicrobial resistance in children is linked to race and socioeconomic factors.
- Race and socioeconomic status are critical considerations for H. pylori treatment strategies in pediatric populations.
- Further research is needed to elucidate mechanisms and guide targeted interventions for pediatric H. pylori resistance.
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.
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