Z Gastroenterol 2015; 53 - P26
DOI: 10.1055/s-0035-1551714

Helicobacter pylori resistance in Southern Austria

I Zollner-Schwetz 1, E Leitner 2, W Plieschnegger 3, G Semlitsch 4, L Reiter 5, V Stepan 6, G Reicht 7, C Bretterklieber 8, E Mörth 9, J Pavek 10, P Parsche 11, W Schneider 1, S Grabner 2, R Krause 1, C Högenauer 12
  • 1Sektion für Infektiologie und Tropenmedizin, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Austria
  • 2Institut für Hygiene, Medizinische Universität Graz, Graz, Austria
  • 3Abteilung für Innere Medizin, Bramherzige Brüder, Krankenhaus St. Veit/Glan, St. Veit/Glan, Austria
  • 4Ordination MedCenter, Judenburg, Austria
  • 5Interne Abteilung, Krankenhaus der Barmherzigen Brüder, Standort Marschallgasse, Graz, Austria
  • 6Abteilung für Innere Medizin, Krankenhaus der Elisabethinen Graz, Graz, Austria
  • 7Abteilung Innere Medizin II, Krankenhaus der Barmherzigen Brüder, Standort Eggenberg, Graz, Austria
  • 8Interne Abteilung, Landeskrankenhaus Rottenmann, Rottenmann, Austria
  • 9Ordination, Lassnitzhöhe, Austria
  • 10Ordination, Weiz, Austria
  • 11Ordination, Kapfenberg, Austria
  • 12Klinische Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Austria

Background: A recent European study revealed clarithromycin primary resistance in Helicobacter pylori to be the highest in Austria among all 18 participating countries (36.6%; Megraud F, Gut, 2013). Austria was represented by a single center, it is therefore not feasible to infer from this data on regional resistance patterns. As the rate of clarithromycin resistance is crucial for the choice of the eradication regime, we aimed to evaluate primary and secondary resistance rates of H. pylori in Southern Austria in 10 centers.

Methods: In a prospective multicenter study conducted in 2014 in Styria and Carinthia, stomach biopsies were taken from patients during routine gastroscopy. A history of previous H. pylori eradication attempts was obtained in every patient. H. pylori was cultivated and the MICs for standard antimicrobials were determined according to EUCAST. Resistance to clarithromycin was determined by sequencing of the peptidyltransferase loop region of the 23S rRNA gene.

Results: 115 H. pylori isolates were cultivated from patients without prior eradication therapy. Primary resistance to clarithromycin, levofloxacin and metronidazole was 15.7%, 10.4% and 7.8% respectively (table 1). None of the strains were resistant to amoxicillin and tetracycline. 23 isolates were cultivated after failed eradication therapy; in these isolates resistance to clarithromycin, levofloxacin and metronidazole was 65.2%, 13% and 30.4% respectively (table 1). None of these strains were resistant to amoxicillin and tetracycline. Of 29 clarithromycin resistant isolates tested, the predominant mutations found were A2143G in 17 and A2142G in 6 isolates.

Conclusion: Primary resistance to clarithromycin and levofloxacin was markedly lower in Southern Austria than recently published. Our findings suggest that the classic triple therapy consisting of PPI, clarithromycin and amoxicillin is still a valid empiric eradication option in Southern Austria.

Resistance to

Primary resistance

(without prior eradication)

n = 115

Secondary resistance

(after failed eradication)

n = 23

Clarithromycin

15.7%

65.2%

Levofloxacin

10.4%

13%

Metronidazole

7.8%

30.4%

Rifampicin

6.1%

0%

Tetracycline

0%

0%

Amoxicillin

0%

0%