P250 Personalised medicine: is this the way to combat helicobacter pylori (HP) eradication failure?

Introduction Antibiotic-resistant HP varies in different geographical areas. A recent review of international guidelines suggest evidence-based locally relevant treatment strategies. Within the United Kingdom, hospitals develop local antibiotic guidelines as per local resistance rates. However, Public Health England (PHE) recommendation for treatment regimes in primary care remains to be clarithromycin and metronidazole-based regimes for patients with dyspepsia who are HP positive. The Gastrointestinal Bacteria Reference Unit (GBRU), PHE is the national reference laboratory which tests all HP cultures in England. We aimed to look local HP secondary resistance data from 3 different units in London and compared whether variation in specimen collection practice impacted on rates of HP culture positivity. Methods We compared culture data from 3 different units in London. Due to differences in the local databases used, the date ranges of data collected was varied. We obtained 34 months data between March 2016 and December 2018 from Homerton University Hospital (HUH). There were no local guidelines at HUH regarding number of biopsy samples taken and samples were transported to the lab routinely. Culture data from Guys & St Thomas’ Hospital (GST) was for 10 months between January to October 2019. At least 4 to 6 samples were taken on Monday to Thursday morning lists to ensure samples are sent to reference lab urgently. Culture data from Newham University Hospital (NUH) was for 12 months from October 2018 to October 2019. At least 6 gastric biopsy samples were taken on a dedicated endoscopist’s list on a weekday morning and samples were urgently transported by taxi to the laboratory. Results 122 gastric biopsy samples were sent in HUH and 36 isolated HP, giving a 29.5% positive culture rate. 112 gastric biopsy samples were sent in GST and 72 isolated HP, giving a 64.2% positive culture rate. 34 gastric biopsy samples were sent in NUH and 15 isolated HP, giving a 44.1% positive culture rate. Conclusion 38% of UK’s foreign born population live in London. Variation in concentrations of migrant communities within a city can lead to variations in antimicrobial resistance. Our results are skewed towards resistant isolates as patients having gastroscopy and cultures taken for HP sensitivity would have had multiple courses of antibiotics. They suggest a benefit in tailoring local second line antimicrobial guidelines to local resistance rates. Given the lack of amoxicillin resistance, we recommend penicillin allergy testing for patients who report allergy.