Antimicrobial resistance of Helicobacter pylori in West Flanders – Belgium: an observational cross-sectional study

ABSTRACT

Objectives

Data on Helicobacter pylori (HP) resistance in Belgium are largely based on the patient population of Brussels and Wallonia. Notably Brussels harbours a large proportion of patients with a migration background which might not be representative for other parts of the country.

Methods

An observational cross-sectional study was performed in the province of West Flanders, Belgium for collecting gastric biopsies to examine the resistance of HP. The study population consisted of patients who underwent a gastroduodenoscopy for any medically indicated purpose. Rapid urease testing (RUT) was performed on all biopsies and cultures were only started if the RUT showed positive.

Results

512 patients participated of whom 495 were eligible for analysis: 438 in first line testing and 57 in second line. The growth of HP was successful in 88.9% (n = 88/99) of which 52.3% (n = 46/88) resulted in an antibiogram. The resistance rate in first line was based on 37 succeeded antibiograms and showed 13.5% resistance for clarithromycin (95% confidence interval; 2.5% to 24.5%); 29.7% for metronidazole; 29.7% for levofloxacin; 11.4% for rifampicin; 2.7% for amoxicillin and 0% for tetracycline.

Conclusion

The primary clarithromycin resistance rate of HP could still be slightly under 15% in West Flanders, Belgium. This might implicate a clarithromycin-based triple therapy is an option for first line empiric eradication in this region according to the Maastricht V/Florence consensus although conclusions must be interpreted with caution due to the rather small sample size. Further testing in Flanders is recommended to confirm these results.

KEYWORDS:

• Helicobacter pylori
• belgium
• antibiotic
• resistance
• prevalence

Acknowledgments

We would like to express our deep gratitude to all the endoscopic nurses, laboratory staff and doctors of gastroenterology, microbiology and pathology of the 4 recruitment centres for their unremunerated effort in the contribution of this study. Also a big thank you to the medical laboratory for funding this project and to the patients for participating.

Disclosure statement

The authors report no declarations of interest.

Geolocation

Belgium, West Flanders