A128 ANTIBIOTIC RESISTANCE DOES NOT FULLY EXPLAIN <i>HELICOBACTER PYLORI</i> TREATMENT FAILURES
Notice bibliographique
Résumé
Abstract Background Most treatment failures of Helicobacter pylori are attributed to antibiotic resistance or patient nonadherence. Commonly used 1st-line treatment regimens include 14 day concomitant [proton pump inhibitor(P), amoxicillin(A), metronidazole(M), and clarithromycin(C):PAMC], or bismuth-based quadruple therapy [P, Bismuth(B), M, and tetracycline(T):PBMT]. Levofloxacin(L)-based PAL is also suggested for 14 days and rifabutin(R)-based PAR for 10 days. Analyses of data on the frequency of treatment failures in antibiotic sensitive cases are scarce. Aims To determine the proportion of H. pylori treatment failures not explained by antibiotic resistance. Methods Cultures of H. pylori positive patients (by histology, urea breath test, or stool antigen test) at the University of Alberta Hospital in Edmonton, Canada were assessed for resistance by E-test according to EUCAST thresholds to C, M, A, T, and L measuring minimum inhibitory concentrations. Results There were 68 positive cultures from 64 individuals in 292 cases. Treatment adherence was high in patients with follow-up (FU) testing available. Median number of antibiotic regimens received prior to culture was 2 (IQR 0-3). In patients not previously treated, overall cure rate was 10/17 (59%) vs 21/47 (45%) for those who had been previously treated (p=.32). Summary data on outcomes are shown in Fig 1. Clarithromycin: 14/63 (22%) cases had C-sensitive cultures. Regimens containing C were successful in 5/8 (63%), failures were PAC(1), Sequential therapy (1), and PMC(1). Of C-sensitive cases, 5/14 (36%) had been previously treated with C: further treatment success was 1/2 with PAR and 0/1 with PAL. Metronidazole: 25/52 (48.0%) cases were M-sensitive: 11 cases were treated with M-containing regimens. 80% (8/10) were successfully treated with PBMT or PAMC, 1 case failed. Success with non-M regimens was 67% (4/6) with PAR and 1/2 with PAL. PBMT was successful in 60% (3/5) of M-sensitive patients with prior M-exposure. 43% (22/51) of cases had dual resistance to C and M. In 5 cases who were sensitive to both C and M, 60% (3/5) were cured with PAMC, 1 declined treatment and 1 was lost to FU. Levofloxacin: 22/57 (39%) cases were L-sensitive of which 41% (9/22) had been previously treated with PAL. Successful treatment with PAL was 67% (4/6) in L-sensitive cases. There were no cases of T-resistance (0/66). Borderline A-resistance was observed in 9% (4/46) of cases. Conclusions H. pylori treatment failures are not fully explained by antibiotic resistance. A substantial proportion (27-41%) of patients failed despite being sensitive to the antibiotics used (C, M, L). M resistance can be partially overcome with combination treatment. Resistance to A and T is rare. Clinical history including adherence is an important complement to antibiotic resistance testing in H. pylori, especially to determine previous C exposure. Figure 1: Treatment success in confirmed cases with antibiotic-sensitive H. pylori cultures. Abbreviations: PPI, proton pump inhibitor; PAMC, PPI-amoxicillin-metronidazole-clarithromycin; PAC, PPI-amoxicillin-clarithromycin; PMC, PPI-metronidazole-clarithromycin; PAR, PPI-amoxicillin-rifabutin; PAL, PPI-amoxicillin-levofloxacin; PBMT, PPI-bismuth-metronidazole-tetracycline; PAM, PPI-amoxicillin-metronidazole; PBAT, PPI-bismuth-amoxicillin-tetracycline Funding Agencies None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».