A167 ANTIMICROBIAL SUSCEPTIBILITY OF HELICOBACTER PYLORI IN THE SASKATOON HEALTH REGION

Abstract

Background

Helicobacter pylori infection has been implicated in the development of duodenal or gastric ulcers, early gastric cancer and gastric mucosa-associated lymphoid tissue lymphomas. The increasing prevalence of antibiotic-resistant strains of H pylori have led to reduced success with traditional H pylori treatments; with some studies reporting eradication in less than 50% of cases. There has been no study completed, to this date, which has investigated regional antibiotic resistance patters of H pylori in the Saskatoon Health Region.

Aims

Primary Outcome: Is to assess the susceptibility of H. pylori strains isolated from gastric biopsies of patients with peptic ulcer disease to Amoxicillin, Metronidazole, Clarithromycin, Tetracycline, Levofloxacin, Moxifloxacin, and Rifabutin.

Secondary Outcome:

1) Standardizes the treatment of H pylori in the Saskatoon Health Region

2) Reduction in healthcare costs associated with inappropriate antibiotic prescribing

3) Analyze potential predictors of H pylori resistance

4) Accuracy of CLO test versus histology in the diagnosis of H pylori

Methods

This is a prospective study patients suspected to have peptic ulcer disease typically undergo an EGD and biopsies are removed to test for H pylori. For our study, additional biopsies will undergo a CLO test. If the CLO test is positive, the biopsy sample will be sent to the clinical microbiologist for culture and susceptibility testing. We will be looking at the susceptibility of the 50 strains of H pylori to 7 antibiotics, which include: Amoxicillin, Metronidazole, Clarithromycin, Tetracycline, Levofloxacin, Moxifloxacin, and Rifabutin. Prior to undergoing an EGD patients will be invited to participate in a survey, which will collect demographic, lifestyle factors, history of H pylori and treatment and EGD diagnosis.

Results

Unfortunately, our project was initiated recently and our results are preliminary. To date, 14 patients have been enrolled of which half are male. The mean age of our cohort is 55.3 (13.5) without a significant age discrepancy between sexes. In our enrolled cohort to date, the CLO test has perfect specificity (100%) but lacks sensitivity (50%). The relative risk of patients who identify as “East Asians” or “First Nations” having H pylori was 14. A McNemar’s test with continuity correction determined that both the CLO test and pathology results were statistically comparable to one another (p < 0.001). Antimicrobial susceptibility testing results for specimens were pending at the time of this report submission.

Conclusions

For a cohort size of 14 patients, we have demonstrated and validated the reliability and specificity of CLO test in comparison to histology in the diagnosis of H pylori. Our project is promising and we hope to continue recruitment. Most importantly, our project has economical insights, as we continue to analyze results in our growing cohort.

Funding Agencies

None