Need for standardization and harmonization of Helicobacter pylori antimicrobial susceptibility testing

• Published in: Helicobacter (Cambridge, Mass.) Mass.), 2022-04, Vol.27 (2), p.e12873-n/a
• Main Authors: Li, Hong, Shen, Yalin, Song, Xiaona, Tang, Xiaoqiong, Hu, Renwei, Marshall, Barry James, Tang, Hong, Benghezal, Mohammed
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; antimicrobial susceptibility testing; Breakpoints; Clarithromycin; Dilution; Drug resistance; Drug Resistance, Bacterial; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Infectious diseases; Microbial Sensitivity Tests; Reference Standards; Standardization; Susceptibility
• ISSN: 1083-4389; 1523-5378
• DOI: 10.1111/hel.12873

Background and aims As with other infectious diseases, Helicobacter pylori eradication regimens should be guided by susceptibility testing to achieve excellent success rate, especially in the era of high antibiotic resistance. However, susceptibility testing for H. pylori is rarely performed, which can be partly ascribed to the current lack of standardization of testing methods and the lack of unified consensus on the antibiotic resistance breakpoints. The aim of this review was to call for an international consensus on standardization and harmonization of H. pylori susceptibility testing. Methods We summarize and compare the advantages and disadvantages of four different phenotypic antimicrobial susceptibility testing (AST) methods (agar dilution, E‐test, disk diffusion, and broth microdilution) and the molecular susceptibility testing method for H. pylori. Results The standard phenotypic testing methods and the molecular testing methods have their own advantages and disadvantages. Compared to the standard phenotypic methods, the molecular testing method does not require successful H. pylori culture, and therefore, is much more rapid and convenient for clinical use. However, the currently available molecular testing method is only suitable for detecting clarithromycin and quinolone susceptibility profiles in H. pylori. Although the standard AST is time‐consuming, it is currently the only way to test the susceptibility of H. pylori to all the commonly used antibiotics. Conclusion To make H. pylori susceptibility testing become a clinical routine, an international consensus on standardization and harmonization of H. pylori AST is needed. Future efforts are needed for optimizing broth culture of H. pylori, and developing commercial AST plates for achieving high throughput and automated susceptibility testing for H. pylori.