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Using droplet digital PCR to detect clarithromycin resistance in stored urease test samples serves as a dependable indicator of H. pylori therapy effectiveness.
Helicobacter pylori (H. pylori) continues to pose a global health concern as a major cause of peptic ulcers and gastric cancer while escalating clarithromycin resistance has sharply diminished the success of standard triple therapy. In New Zealand, the prevalence and clinical impact of this resistance are not fully defined, limiting precision in treatment strategies. Hence, investigators aimed to determine the clinical utility and feasibility of identifying clarithromycin resistance genes via droplet digital polymerase chain reaction (ddPCR) on stored rapid urease test (RUT) samples. They also sought to assess how resistance status influenced outcomes after empiric first-line triple therapy.
In this cohort study, patients with positive RUT results during gastroscopy received omeprazole-based triple therapy. Stored RUT samples were analyzed by ddPCR to detect clarithromycin resistance genes. Treatment success was assessed via follow-up H. pylori stool antigen testing. Associations between resistance, infection burden, treatment regimen, and eradication outcomes were analyzed to identify key determinants of therapy effectiveness. Among 84 patients, clarithromycin resistance genes were identified in 13 (15.5%).
Overall, eradication was attained in 74 patients (88.1%). Eradication rates were dramatically lower in resistant cases (38.5%) compared to non-resistant patients (97.2%, p < 0.001). Neither infection burden, treatment regimen, nor duration considerably impacted outcomes, underscoring resistance status as the primary driver of therapy failure. Resistance prevalence was similar between Māori and Pacific patients (18.2%) and other ethnic groups (14.8%), though small subgroup sizes limited definitive conclusions.
The study confirmed that ddPCR on stored RUT samples is a reliable, actionable method for checking clarithromycin resistance. Findings highlight that resistance, rather than bacterial load or treatment approach, determines eradication failure. Molecular-guided therapy offers a pathway to improve eradication rates, optimize antibiotic stewardship, and establish non-invasive PCR-based screening programs for broader clinical and public health applications.
Helicobacter
Droplet Digital PCR-Based Detection of Clarithromycin Resistance on Rapid Urease Test Samples Predicts Helicobacter pylori Eradication Success: A New Zealand Cohort Study
Stephen James Inns et al.
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