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Updated: May 7, 2025
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Published on: March 7, 2025
Updating Primary Antibiotic Resistance in Helicobacter pylori Strains Isolated in Italy
Ilaria Maria Saracino1, Matteo Pavoni2, Giulia Fiorini3
1Department of Medical and Surgical Sciences, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy. . ilariamaria.saracino@studio.unibo.it.
Background And Aims:
Bacterial resistance toward the most used antibiotics is increasing in Helicobacter pylori (H. pylori) strains worldwide. The emergence of multidrug resistance significantly affects the efficacy of standard therapy regimens. Therefore, this prospective study has updated the prevalence rates of primary antibiotic resistance in H. pylori strains isolated in routine practice.
Methods:
H. pylori isolates obtained from patients consecutively observed in a single center were tested for primary resistance by using the E-test method. The minimum inhibitory concentration (MIC) breakpoints to define resistance to clarithromycin, metronidazole, and levofloxacin were, respectively, greater than 0. 25 mg/L, 8 mg/L, and 1 mg/L, according to updated EUCAST recommendations. The trend of antibiotic prevalence, either single or combined, during 2020-2023 was assessed.
Results:
A total of 789 patients meeting inclusion criteria were diagnosed with H. pylori infection, but bacterial strains were overall recovered in 632 (80.1%) cases. At bacterial culture, primary resistance rate was 36.7% for clarithromycin, 32.8% for metronidazole, and 22.1% for levofloxacin, whilst dual clarithromycin-metronidazole resistance rate was detected in 17.4%, and triple resistance in 9%.
Conclusions:
Our data found that primary resistance towards both clarithromycin and metronidazole, as well as dual resistance, is substantially stable in Italy whilst the prevalence of levofloxacin resistance seems to be decreasing in our geographic area.
Insights
Antibiotic resistance in Helicobacter pylori is a growing concern. This study found clarithromycin and metronidazole resistance rates stable in Italy, while levofloxacin resistance appears to be decreasing.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Increasing bacterial resistance to antibiotics in Helicobacter pylori (H. pylori) strains globally impacts standard therapy efficacy.
- Multidrug resistance in H. pylori poses a significant challenge to treatment outcomes.
- There is a need for updated prevalence data on primary antibiotic resistance in H. pylori.
Purpose of the Study:
- To update the prevalence rates of primary antibiotic resistance in H. pylori strains.
- To assess the trends in antibiotic resistance in H. pylori over a defined period.
- To evaluate resistance patterns to clarithromycin, metronidazole, and levofloxacin.
Main Methods:
- Prospective study analyzing H. pylori isolates from routine clinical practice.
- E-test method used to determine minimum inhibitory concentrations (MICs) for key antibiotics.
- Updated EUCAST breakpoints applied to define resistance to clarithromycin, metronidazole, and levofloxacin.
Main Results:
- Primary resistance rates: 36.7% for clarithromycin, 32.8% for metronidazole, and 22.1% for levofloxacin.
- Dual clarithromycin-metronidazole resistance detected in 17.4% of isolates.
- Triple resistance observed in 9% of H. pylori strains.
Conclusions:
- Primary resistance to clarithromycin and metronidazole, and dual resistance, remain stable in Italy.
- The prevalence of levofloxacin resistance in H. pylori strains shows a decreasing trend in the studied geographic area.
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