Routine Susceptibility Testing of Helicobacter pylori in Clinical Practice-Results of a Prospective Multicentre Study

Background/Objectives: Helicobacter pylori (HP) antibiotic eradication treatment in Germany is, at present, empirical according to the national guidelines. The aim of our prospective multicentre study was to implement routine susceptibility testing in daily clinical practice to facilitate resistance-oriented first-line antibiotic therapy and to collect local resistance data. Methods: From 1 January 2024 to 30 April 2025, in two German hospitals (in Bielefeld and Datteln), the patients who underwent gastroscopy and those who had biopsies for histopathology also underwent biopsies for the Helicobacter urease test (HUT). Positive HUT samples were sent for susceptibility testing: they were checked for phenotypic/cultural resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, rifampicin and tetracycline and genotypic/molecular resistance to clarithromycin and fluoroquinolones. Results: In total, in 1503 cases, both HUT and histology were performed, in which 256 (17.0%) histologies were HP-positive. We sent 311/1503 (20.7%) positive HUTs for susceptibility testing. In 120 (38.6%) of them, it was possible to culture HP, and for 118 cases, phenotypic resistance testing was performed. In 200/311 cases, PCR was also executed, with 111/200 cases being subjected to subsequent molecular resistance testing. Resistance patterns varied regionally, with metronidazole resistance observed in 3-33%, clarithromycin resistance in 16-20% and levofloxacin resistance in 13-16% cases. Conclusions: it is technically and logically feasible to perform HP antibiotic susceptibility testing via the same biopsy used for the HUT. The proposed procedures might be applied both in hospital and outpatient settings in endoscopic offices. Routine susceptibility testing is useful not only for the individual patient but also for monitoring the development of regional resistance patterns as a basis for better-targeted empiric therapy. Additionally, this approach might help to reduce the resistance dynamics at large in terms of antimicrobial stewardship.