Recently, a study on the latest characteristics of Helicobacter pylori (HP) infection and antibiotic resistance among urban population in Chinese cities was published in The Lancet Microbe. The study was conducted by Professor Gu Bing, Director of the Department of Clinical Laboratory at Guangdong Provincial People's Hospital, in collaboration with Nobel laureate Professor Barry J. Marshall from the University of Western Australia Medical School.
Research shows that the average H. pylori infection rate among urban populations in China is 27.08%, significantly lower than the estimated 44.2% for the total population of China. Additionally, it was found that the resistance rates to clarithromycin and levofloxacin are relatively high among urban populations in China, with average resistance rates of 50.83% and 47.17%, respectively.
According to Barry Marshall, antibiotic resistance data serves two important purposes. Firstly, by avoiding resistant antibiotics, personalized medicine can be directly applied, avoiding wasted time and ineffective treatments. Secondly, for approximately 50% of patients still carrying sensitive strains nationwide, simple, safe, and low-side-effect antibiotics can be used. "We eagerly anticipate further analysis of this data to yield some exciting research outcomes."
Academician Liao Wanqing, who was not involved in this study, commented during an interview with the Chinese Science Bulletin as follows: This study provides empirical data for understanding the real situation of H. pylori infection and resistance among urban populations in China, emphasizing the urgency of targeted resistance control strategies. The high resistance rates to clarithromycin and levofloxacin highlight the urgency of adopting treatment guided by drug sensitivity testing in clinical practice to improve the success rate of eradicating H. pylori infection.
Male infection rates higher than females
Currently, China faces a heavy burden of H. pylori infection resistance. However, methods for studying the infection and resistance rates of H. pylori among large populations in China often rely on meta-analyses and systematic reviews, with issues such as diverse detection methods and mixed participant populations.
"Therefore, there is an urgent need to use a single methodology to conduct large-scale screening for the current status of H. pylori infection resistance among healthy populations," said Gu Bing. This study utilized the capsule sampling line method combined with quantitative PCR technology to conduct cross-sectional screening for H. pylori infection resistance among urban populations nationwide, aiming to understand the latest situation of H. pylori infection rates and clarithromycin and levofloxacin resistance rates in China.
The screening period for the study was from March 2023 to November 2023, covering 52 cities in 26 provinces across China, with a total of 12,902 healthy individuals included in the study, including 4,375 males and 8,527 females.
The study showed that among all participants, 3,494 individuals (27.08%) tested positive for H. pylori, with males (28.85%) having a significantly higher positivity rate than females (26.18%). Among them, the age group of 30 to 49 had the highest infection rate, at 28.98%.
Subsequently, the researchers conducted resistance gene testing on individuals positive for H. pylori, mainly focusing on clarithromycin and levofloxacin antibiotics. Among H. pylori-infected individuals, 1,776 people (50.83%) showed resistance to clarithromycin, with 1,202 females (53.85%) and 574 males (45.48%), with females significantly higher than males. Among them, the resistance to clarithromycin was generally over 50.83% in the age group of 40 to 60.
Regarding resistance to levofloxacin, among the 1,648 individuals with resistance, females (49.01%) were also higher than males (43.90%). Among them, the resistance to levofloxacin was consistently higher in the age group of 40 to 60 (54.54%).
As for why there is an increase in resistance to clarithromycin and levofloxacin in the age group of 40 to 60, Gu Bing believes it may be related to increased susceptibility to respiratory and urinary tract infections with age, as well as increased exposure to corresponding antibiotics. Compared to males, the higher prevalence of resistance to clarithromycin and levofloxacin in females may be related to frequent use of these antibiotics to treat gynecological infections.
"The above research results indicate the importance of controlling H. pylori infection resistance among urban populations in China, and also suggest that in clinical practice, an HP precise treatment method based on drug sensitivity testing should be adopted to effectively improve the success rate of eradicating H. pylori infection," Barry Marshall told reporters.
Northeast China has the highest resistance rates
Researchers analyzed the H. pylori infection rates among urban populations in seven geographical regions of China (North China, Northeast China, East China, Central China, South China, Northwest China, Southwest China) and found that East China had the highest infection rate, followed by Northeast, North, and Northwest China, while South and Southwest China had lower infection rates, and Central China had the lowest infection rate.
Against the backdrop of current antibiotic resistance, the resistance rate to clarithromycin is increasing in northern provinces, with the Northeast region having the highest clarithromycin resistance rate (75.28%), particularly in Heilongjiang and Jilin, reaching 77.08% and 77.91%, respectively, significantly exceeding the resistance rates in North, Northwest, and East China, although the resistance rates in these regions also exceeded 50%.
In addition, regarding levofloxacin resistance rates, the Northeast region still has the highest rate at 57.30%, while the Northwest and East regions are 51.52% and 50.10%, respectively, and the Central region has the lowest rate among the seven geographical regions at 39.22%.
"This indicates that regional differences in H. pylori infection and antibiotic resistance may be related to local socioeconomic conditions, sanitary conditions, accessibility of medical facilities, and antibiotic usage practices," Gu Bing told the Chinese Science Bulletin.
Further in-depth research will be conducted
China has a high prevalence, high resistance, and high disease burden of H. pylori. Over the past few decades, the infection rate of H. pylori in the Chinese population has been declining, but resistance phenomena have become more severe, and there is a serious lack of updated data reflecting the overall national situation.
"This study, using a non-invasive capsule sampling line combined with qPCR method, found a lower infection rate and higher clarithromycin and levofloxacin resistance rates in the population than previous data, which is very worthy of attention. In particular, the sampling method used in this study eliminates the dependence on gastroscopy and is suitable for epidemiological investigations of H. pylori infection and resistance among rural and remote populations, for whom relevant information has been largely lacking in recent years," said Zhang Jianzhong, the project leader of the "H. pylori Infection Prevention and Control in China" white paper project and chief expert in bacteriology at the Chinese Center for Disease Control and Prevention.
"The gradual increase in H. pylori resistance is mainly due to widespread antibiotic use, irregular medication, and patients interrupting treatment on their own. Conducting single-method studies on urban populations for H. pylori infection and resistance screening is of great significance. In the short term, it can help with dissemination, prevention, and treatment, and in the long term, it can help reduce the overall gastric cancer incidence in the population. This research helps formulate comprehensive and targeted strategies for the prevention and control of H. pylori, effectively addressing the current serious problem of infection resistance," said Wang Chuanxin, director of the Chinese Medical Association's Branch of Laboratory Medicine and professor at the Second Hospital of Shandong University. So, what's next for the research team? Gu Bing mentioned that this year they will kick off the second phase of the project, starting in Guangdong province. They aim to comprehensively understand the characteristics of Helicobacter pylori infection and drug resistance in rural populations through non-invasive screening. The outcomes of the project will provide evidence for public health policies on the prevention and precision treatment of H. pylori infection, promoting overall health improvement in rural areas and contributing to the Healthy China strategy.
Gu Bing, Barry J. Marshall, and Professor Zheng Jingyuan, director of the H. pylori laboratory at the University of Western Australia, are corresponding authors. Professor Wang Liang, chief researcher of the Laboratory Medicine Department at Guangdong Provincial People's Hospital, and Professor Li Zhengkang, group leader of the Clinical Molecular Diagnostics Group and secretary of the Guangdong Clinical Gene Testing Quality Control Center, are the first authors. The research received funding support from the National Key Research and Development Program, the National Natural Science Foundation of China, the Guangdong Provincial Basic and Applied Basic Research Fund, the "Three Tops" of Medical and Health of Shenzhen, and the Guangdong Provincial People's Hospital High-level Talent Introduction Fund.
For more details, check out the related paper: https://doi.org/10.1016/S2666-5247(24)00027-2
