Antimicrobial susceptibility testing for Helicobacter pylori comes of age

Helicobacter pylori eradication has become more difficult over time, mainly because of increases in resistance to many of the antimicrobials used in treatment regimens. 1 Megraud F Bruyndonckx R Coenen S et al. Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community. Gut. 2021; 70: 1815-1822 Crossref PubMed Scopus (88) Google Scholar Antimicrobial susceptibility testing is fundamental to population-based resistance surveillance, with consensus guidelines recommending that H pylori treatment be guided by the local prevalence of antimicrobial resistance. 2 Malfertheiner P Megraud F Rokkas T et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022; 71 (gutjnl-2022-327745.) Crossref PubMed Scopus (109) Google Scholar Thus, resistance surveillance through antimicrobial susceptibility testing enables the selection of optimal treatment regimens for the test-and-treat approach, while encouraging more prudent use of antimicrobials and minimising potential development of resistance. 2 Malfertheiner P Megraud F Rokkas T et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022; 71 (gutjnl-2022-327745.) Crossref PubMed Scopus (109) Google Scholar Antimicrobial susceptibility testing also provides the opportunity for individualised therapy. Traditionally, antimicrobial susceptibility testing has been done with H pylori isolated from gastric biopsy specimens taken during endoscopy. These culture-based methods are highly specific and can be used to detect phenotypic resistance to all antimicrobials currently in use for H pylori treatment. 3 Lehours P Mégraud F Culture-based antimicrobial susceptibility testing for Helicobacter pylori. Methods Mol Biol. 2021; 2283: 45-50 Crossref PubMed Scopus (4) Google Scholar However, H pylori is a microaerophilic, fastidious bacterium and culture is time consuming, with specific sample transport and culture conditions required. Additionally, concurrent use of proton pump inhibitors inhibits H pylori and further reduces the chances of successful culture. Because of these challenges, H pylori culture and antimicrobial susceptibility testing are not routinely done at most hospitals. Molecular antimicrobial susceptibility testing methods enable detection of H pylori DNA directly from biopsy samples, without the need for culture, and are less affected by proton pump inhibitor use. 4 Smith SM O'Morain C McNamara D Helicobacter pylori resistance to current therapies. Curr Opin Gastroenterol. 2019; 35: 6-13 Crossref PubMed Scopus (21) Google Scholar Molecular methods also offer a more rapid diagnostic option than culture (same day vs 7–10 days), with less stringent sample storage and transport requirements. Molecular testing-guided therapy versus susceptibility testing-guided therapy in first-line and third-line Helicobacter pylori eradication: two multicentre, open-label, randomised controlled, non-inferiority trialsMolecular testing-guided therapy was similar to susceptibility testing-guided therapy in first-line therapy and non-inferior to susceptibility testing guided therapy in third-line treatment of H pylori infection, supporting the use of molecular testing-guided therapy for H pylori eradication. Full-Text PDF