PTH-031 Helicobacter pyloriresistance: culture as opposed to serology

Introduction Helicobacter pylori infection is a well recognised in causing a number of gastrointestinal pathologies. At endoscopy, the diagnosis of H pylori is usually done through urease based tests or histopathology on a gastric biopsy. There has been increasing resistance to the first line of antibiotics used1 reported and that failure of first line treatment increases the antibiotic resistance in H pylori.2 The Maastricht III consensus report recommends that culture and sensitivity testing should be routinely performed before clarithromycin-based treatment, if primary resistance to clarithromycin is >15%–20% in the respective area or after two treatment failures with different antibiotics. Our practice is to carry out routine H pylori culture and sensitivity at endoscopy for those with an appropriate indication as a first line test. In this study we aim to look for the pattern of resistance to antibiotics in our cohort of patients. Methods We retrospectively identified positive H pylori culture results from Jan 2004 to Dec 2008 from microbiology database and reviewed the endoscopy report of all these patients. Results 356 H pylori positive cultures were identified, of these 83 were females and 173 males. The mean age of patients was 67.3 (range 23–97). 169 (47.5%) isolates were resistant to at least one antibiotic of which 141 (39.6%) were resistant to one and 28 (7.8%) were resistant to two or more antibiotics. 137 (38.4%) were resistant to metronidazole, 38 (10.6%) to clarithromycin, 9 (2.5%) to amoxicillin, 4(1%) to tetracycline and 2 (0.5%) to furazolidone. Eradication was confirmed through stool antigen/urea breath test in 38 (10.5%) patients, however 9 (2.5%) of the patients did not eradicate the bacteria despite appropriately selected H pylori eradication therapy. In 309 patients there was no documentation of the eradication, we presume lack of follow-up or patient compliance with the test. Conclusion Our study shows a high incidence of resistance to the standard first line antibiotics used in eradication of H pylori. This includes a significant primary resistance. This has implications in clinical and cost effective H pylori eradication. Our study was limited in that we could not ascertain if the patients had previously failed eradication in the community or if they had prior use of these antibiotics for other reasons. We aim to study antibiotic resistance prospectively in our population to elucidate possible causes for the same.