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J Med Microbiol 58 (2009), 94-100; DOI: 10.1099/jmm.0.003855-0
© 2009 Society for General Microbiology
ISSN 0022-2615

Evaluation of clinical and socio-demographic risk factors for antibacterial resistance of Helicobacter pylori in Bulgaria

Lyudmila Boyanova1, Juliana Ilieva2, Galina Gergova1, Zoya Spassova3, Rossen Nikolov3, Lubomir Davidkov4, Ivailo Evstatiev4, Victor Kamburov5, Nikolai Katsarov6 and Ivan Mitov1

1 Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria

2 University Department of Social Medicine and Healthcare Management, Medical University of Sofia, Sofia, Bulgaria

3 Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria

4 Departments of Gastroenterology and General Surgery, University Hospital St Ekaterina, Sofia, Bulgaria

5 Urgent Endoscopy Unit, Emergency Hospital Pirogov, Sofia, Bulgaria

6 Second Surgery Department, University Alexander Hospital, Sofia, Bulgaria

Correspondence
Lyudmila Boyanova
lboyanova{at}hotmail.com
or
l.boyanova{at}lycos.com

Received May 25, 2008
Accepted September 23, 2008

The aim of this study was to assess the clinical and socio-demographic risk factors for primary Helicobacter pylori antibacterial resistance. In total, 266 consecutive H. pylori strains, from untreated symptomatic adult patients who answered a questionnaire, were evaluated. Strain susceptibility to amoxicillin, metronidazole, clarithromycin and tetracycline was tested by a breakpoint susceptibility test. Metronidazole resistance was found in fewer (17.0 %) peptic ulcer patients than in non-ulcer subjects (28.3 %, P=0.037), as well as in fewer patients born in villages (12.7 %) than in those born in towns (27.6 %, P=0.016). Clarithromycin resistance varied from 8.8 to 23.4 % (P=0.009) within the hospital centres. The highest clarithromycin resistance rate was found in hospital centre A (23.4 %) compared to other centres (12.9 %, P=0.041). The factors sex, age, symptom duration, non-steroidal anti-inflammatory drug use, diabetes, type of profession and educational level were not associated with H. pylori resistance. Logistic regression revealed that the risk factors for metronidazole resistance were non-ulcer disease [odds ratio (OR) 1.95, 95 % confidence interval (95 % CI) 1.04–3.65] and a birthplace of a town (OR 2.64, 95 % CI 1.18–5.93). The hospital centre may be a risk factor (OR 2.07, 95 % CI 1.02–4.21) for clarithromycin resistance but further studies are required to verify this suggestion. In conclusion, the knowledge of the risk factors for H. pylori resistance to antibacterials could facilitate the treatment choice for H. pylori eradication.

Abbreviations: 95 % CI, 95 % confidence interval; AUC, area under the curve; NSAID, non-steroidal anti-inflammatory drug; OR, odds ratio; ROC, receiver operating characteristic.






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