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Helicobacter pylori
ORIGINAL ARTICLE
Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption Francis Megraud,1,2 Samuel Coenen,3 Ann Versporten,3 Manfred Kist,4 Manuel Lopez-Brea,5 Alexander M Hirschl,6 Leif P Andersen,7 Herman Goossens,3 Youri Glupczynski,8 on behalf of the Study Group participants* 1
INSERM U853, Bordeaux, France Laboratoire de Bacte´riologie, Centre National de Re´fe´rence des Campylobacter et Helicobacter, Universite´ de Bordeaux, Bordeaux, France 3 Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium 4 National Reference Centre for Helicobacter pylori, Institute of Medical Microbiology and Hygiene, University Hospital Freiburg, Freiburg, Germany 5 Instituto de Investigacio´n Sanitaria del Hospital La Princesa, Hospital de la Princesa, Madrid, Spain 6 Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University Vienna, Vienna, Austria 7 Rigshospitalet, Department of Infection Control, Copenhagen University Hospital, Copenhagen, Denmark 8 Laboratoire de Bacte´riologie, Centre National de Re´fe´rence des Helicobacter pylori, Universite´ Catholique de Louvain, CHU Mont-Godinne, Yvoir, Belgium 2
Correspondence to Dr Professor Francis Megraud, Laboratoire de Bacte´riologie e CHU, Pellegrin Place Amelie Raba-Leon, F-33076 Bordeaux cedex, France; francis.
[email protected] Professor Youri Glupczynski, Laboratoire de Bacte´riologie, Cliniques Universitaires UCL de Mont-Godinne 1, Avenue Docteur Gaston Therasse, B-5530 Yvoir, Belgium; gerald.
[email protected] *Study Group participants are listed in appendix 1. Revised 28 March 2012 Accepted 30 March 2012 Published Online First 15 May 2011
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ABSTRACT Objective Resistance to antibiotics is the major cause of treatment failure of Helicobacter pylori infection. A study was conducted to assess prospectively the antibacterial resistance rates of H pylori in Europe and to study the link between outpatient antibiotic use and resistance levels in different countries. Design Primary antibiotic resistance rates of H pylori were determined from April 2008 to June 2009 in 18 European countries. Data on yearly and cumulative use over several years of systemic antibacterial agents in ambulatory care for the period 2001e8 were expressed in Defined Daily Doses (DDD) per 1000 inhabitants per day. The fit of models and the degree of ecological association between antibiotic use and resistance data were assessed using generalised linear mixed models. Results Of 2204 patients included, H pylori resistance rates for adults were 17.5% for clarithromycin, 14.1% for levofloxacin and 34.9% for metronidazole, and were significantly higher for clarithromycin and levofloxacin in Western/Central and Southern Europe (>20%) than in Northern European countries (
