Heteroresistance to clarithromycin and metronidazole in patients with a Helicobacter pylori infection: a systematic review and meta-analysis

• Published in: Annals of clinical microbiology and antimicrobials 2022-05, Vol.21 (1), p.19-19, Article 19
• Main Authors: Kouhsari, Ebrahim, Sadeghifard, Nourkhoda, Khadiv, Arezoo, Sayadi, Hojjat, Amiriani, Taghi, Ghafourian, Sobhan, Valadbeigi, Hassan, Krutova, Marcela
• Format: Article
• Language: English
• Subjects: Amoxicillin - pharmacology; Analysis; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Biopsy; Care and treatment; Clarithromycin; Clarithromycin - pharmacology; Clarithromycin - therapeutic use; Drug resistance; Drug resistance in microorganisms; Drug Resistance, Bacterial - genetics; Genotype & phenotype; Genotyping; Health aspects; Helicobacter infections; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter pylori; Heterogeneity; Humans; Infections; Medical research; Medicine, Experimental; Meta-analysis; Metronidazole; Metronidazole - pharmacology; Metronidazole - therapeutic use; Microbial Sensitivity Tests; Mutation; Patients; Phenotypes; Review; Systematic review; Ulcers
• ISSN: 1476-0711; 1476-0711
• DOI: 10.1186/s12941-022-00509-3

Antimicrobial resistance of H. pylori can lead to treatment failure. Importantly, several studies have reported on heteroresistance, i.e. the presence of resistant and susceptible H. pylori populations in the same sample and/or a difference in the susceptibility patterns between biopsy samples. This meta-analysis aims to provide comprehensive data on the prevalence of metronidazole and clarithromycin heteroresistance and the approaches to their detection. A systematic review was performed after the search of MEDLINE, Scopus and Web of Science. The study outcomes were the weighted pooled prevalence of heteroresistance to clarithromycin and metronidazole in H. pylori positive samples and/or isolates with a subanalysis by continent. A total of 22 studies that had investigated 3852 H. pylori positive patients were included in the meta-analysis. Heteroresistance to clarithromycin was reported in 20 studies, with a weighted pooled prevalence of 6.8% (95% CI 5.1-8.6; 3654 H. pylori positive patients; the substantial heterogeneity I  = 55.6%). Heteroresistance to metronidazole was reported in 12 studies, with a weighted pooled prevalence of 13.8% (95% CI 8.9-18.6; 1670 H. pylori positive patients; the substantial heterogeneity I  = 60.9%). The weighted pooled prevalence of clarithromycin heteroresistance was similar in Asia and Europe (p = 0.174584), however, metronidazole heteroresistance was detected more often in Europe (p