Treatment of Helicobacter Pylori İnfection and the Colonization of the Gastrointestinal System by Resistant Bacteria

Abstract

<jats:title>A<jats:sc>BSTRACT</jats:sc>
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<jats:title>Background and Aims:</jats:title>
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<jats:italic toggle="yes">Helicobacter pylori (H. pylori)</jats:italic> infections are widely treated with antibiotic regimens such as “Amoxicillin 1 gr 2 × 1 tablet, Clarithromycin 500 mg 2 × 1 tablet, and Lansoprazole 30 mg 2 × 1 tablet” for 14 days. We conducted a prospective observational study to explore whether this treatment protocol serves as a predisposing factor for the colonization of resistant gastrointestinal microflora, namely vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase Enterobacterales (ESBL-E), and carbapenem-resistant Enterobacterales (CRE).</jats:p>
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<jats:title>Materials and Methods:</jats:title>
<jats:p>Pre- and post-treatment stool samples from 75 patients diagnosed with <jats:italic toggle="yes">H. pylori</jats:italic>, without a prior treatment history, were cultured and evaluated based on the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria.</jats:p>
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<jats:title>Results:</jats:title>
<jats:p>Of the 75 evaluated patients, a pronounced surge in ESBL-E positivity was observed. Before initiating antibiotic treatment, 12 patients (16%) had ESBL-E-positive strains in their gastrointestinal tract. Notably, this number surged to 24 patients (32%) after the conclusion of the 14-day treatment regimen. The change was statistically significant, with a <jats:italic toggle="yes">P</jats:italic> value of less than 0.002, indicating a clear association between treatment for <jats:italic toggle="yes">H. pylori</jats:italic> and heightened ESBL-E colonization. Notably, VRE and CRE remained undetected in patients throughout the study, suggesting that the treatment regimen may specifically amplify the risk of ESBL-E colonization without affecting VRE and CRE prevalence.</jats:p>
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<jats:title>Conclusions:</jats:title>
<jats:p>As the inaugural report from Turkey on this issue, our study suggests that antibiotic regimens for <jats:italic toggle="yes">H. pylori</jats:italic> eradication contribute to the increased risk of ESBL-positive bacterial colonization in the gastrointestinal tract.</jats:p>
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