Increasing antimicrobial resistance of Helicobacter pylori infection among Saudi patients undergoing upper gastrointestinal endoscopy

There is growing concern about Helicobacter pylori resistance strains being the main agent contributing to eradication failure. In this study, we evaluated the prevalence and antimicrobial susceptibility trends of H. pylori over a period of time. Over a period of seven years a total of 384 biopsy specimens were sent to the microbiology department and evaluated for culturing H. pylori and assess its susceptibility. Biopsy specimens that cultured and where bacterial susceptibility was determined were regarded as H. pylori positive, and specimens that failed to culture were considered H. pylori negative. A total of 221 patients with H. pylori positive were assessed and antimicrobial susceptibility was determined. The overall prevalence of H. pylori infections among Saudis undergoing upper gastrointestinal endoscopy, with indicated specimens, was 57.6%. Antimicrobial susceptibility was evaluated; overall clarithromycin resistance was found to be 4.5% and metronidazole resistance 52.5%. The number of clarithromycin resistant strains has increased significantly from 2.5% in 2008 to 10% in 2014 (P<0.0001), and metronidazole resistance strains from 47% in 2008 to 65% in 2014 (P<0.001). H. pylori infection is very common among Saudi patients with peptic ulcer disease. Resistance of H. pylori against clarithromycin and metronidazole has increased significantly over the seven-year period. This suggests a need to monitor the annual antimicrobial susceptibility pattern.