Prevalence and Risk Factors Associated with Helicobacter pylori Antibiotic Resistance in Cuenca, Ecuador

Introduction. Helicobacter pylori is responsible for a highly prevalent bacterial infection in developing countries, and its adequate pharmacological treatment is essential to prevent serious complications such as gastric cancer. However, at present, the usual treatment has significant failure rates, and its main factor is bacterial resistance. Aim. To identify the frequency and risk factors for resistance to clarithromycin, amoxicillin, azithromycin, metronidazole, and levofloxacin in patients with Helicobacter pylori infection in the Gastroenterology Center, Cuenca, between December 2020 and May 2021. Material and methods. A single-center observational and descriptive study of 157 adult patients who underwent endoscopic procedures and biopsies that were cultured to obtain resistance rates to different antibiotics. Patients were excluded if they did not sign the informed consent if they had received treatment with antibiotics, bismuth and/or proton pump inhibitors, at least two weeks before the procedure, and if they had received prior treatment for Helicobacter pylori, or with upper gastrointestinal bleeding. Information was collected using a form: age, sex, sociodemographics, and access to public services. Data were presented in tables, with relative frequencies and percentages. Pearson’s Chi-square test was used to assess the association between variables. Statistically significant association when p < 0.05. Results. The prevalence of H. pylori infection was 31.2% by urea test and 12.1% by 48-hour culture. The lowest percentage of resistance was observed for levofloxacin (0%), followed by azithromycin at 16.7%; clarithromycin at 21.1%; amoxicillin 25 mcg at 26.3%; amoxicillin 10 mcg at 31.6% and with the highest percentage of resistance, metronidazole at 63.2%. Resistance to metronidazole and amoxicillin 25 mcg was only significantly associated with patient age, being higher in those older than 60 years.
Conclusions. Metronidazole had a high resistance rate in the sample, while levofloxacin had a sensitivity of 100%. Resistance to metronidazole and amoxicillin 25 mcg was associated with patient longevity.