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DOI: 10.1055/a-2645-6481
Etablierung und Optimierung einer routinemäßigen Resistenzbestimmung von Helicobacter pylori zur Förderung einer resistenzgerechten Eradikationstherapie
Establishment and optimization of a routinely resistance testing of Helicobacter pylori to encourage a resistance-guided therapy
Zusammenfassung
In der Therapie einer Helicobacter pylori-Infektion lag der Schwerpunkt bislang auf empirischen Antibiotikaschemata. Angesichts zunehmender Resistenzdynamiken sowie regional unterschiedlicher Resistenzmuster erscheint jedoch eine Resistenzbestimmung bzw. resistenzgeleitete Therapie zielführender. Dies gilt nicht nur zur Steigerung der Effektivität einer individuellen Therapie, sondern auch im Sinne von Antibiotic stewardship. Insbesondere im Rahmen der überwiegend gastroskopischen Diagnostik stehen verschiedene Optionen der Resistenztestung mittels Kultur und PCR zur Verfügung. Daraus lassen sich individualisiert die jeweils optimalen resistenzgerechten Therapieschemata ableiten.
Abstract
The treatment of Helicobacter pylori infection, so far, focussed on empirical antibiotic regimens. Facing increasing resistance dynamics and regionally different resistance patterns, however, resistance testing respectively resistance-guided therapy appears to be more appropriate. This helds not only in order to increase the effectiveness of individual therapy, but also in the sense of antibiotic stewardship. In particular, in the context of predominantly gastroscopic diagnostics, various options for resistance testing using culture and PCR are available. Thus, the optimal resistance-oriented therapy regimens can be derived on an individual basis.
Schlüsselwörter
Helicobacter pylori - diagnostische Möglichkeiten - Eradikationstherapie - resistenzgerechte Therapie - Antibiotic stewardshipKeywords
Helicobacter pylori - diagnostic options - eradication therapy - resistance-guided therapy - antimicrobial stewardshipPublikationsverlauf
Eingereicht: 11. Februar 2025
Angenommen nach Revision: 26. Mai 2025
Artikel online veröffentlicht:
11. September 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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Literatur
- 1 Nationales Referenzzentrum (NRZ) für Helicobacter pylori . Zugriff am 01. Mai 2025 unter: https://www.mvp.uni-muenchen.de/diagnostik/referenzzentrum-helicobacter/
- 2 Tan P, Yeoh KG. Genetics and molecular pathogenesis of gastric adenocarcinoma. Gastroenterology 2015; 149: 1153-1162 e1153
- 3 Fischbach W, Bornschein J, Hoffmann JC. et al. Aktualisierte S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – Juli 2022 – AWMF-Registernummer: 021–001. Z Gastroenterol 2023; 61: 544-606
- 4 Macke L, Vasapolli R, Lang U. et al. HelicoPTER – lokale Prävalenz, Therapieerfolg und Antibiotikaresistenz der Helicobacter pylori-Infektion in Deutschland. Z Gastroenterol 2023; 61: FV01
- 5 WHO. WHO publishes list of bacteria for which new antibiotics are urgently needed. 2017.
- 6 WHO. WHO bacterial priority pathogens list: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. 2024.
- 7 Megraud F, Bruyndonckx R, Coenen S. et al. Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community. Gut 2021; 70: 1815-1822
- 8 Bluemel B, Goelz H, Goldmann B. et al. Antimicrobial resistance of Helicobacter pylori in Germany, 2015 to 2018. Clin Microbiol Infect 2020; 26: 235-239
- 9 Malfertheiner P, Megraud F, Rokkas T. et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut 2022;
- 10 Hofreuter D, Behrendt J, Franz A. et al. Antimicrobial resistance of Helicobacter pylori in an eastern German region. Helicobacter 2021; 26: e12765
- 11 Wüppenhorst N, Draeger S, Stüger HP. et al. Prospective multicentre study on antimicrobial resistance of Helicobacter pylori in Germany. J Antimicrob Chemother 2014; 69: 3127-3133
- 12 Nyssen OP, Perez-Aisa A, Castro-Fernandez M. et al. European Registry on Helicobacter pylori management: Single-capsule bismuth quadruple therapy is effective in real-world clinical practice. United European Gastroenterol J 2021; 9: 38-46
- 13 Losurdo G, Pricci M, De Bellis M. et al. Effect of metronidazole resistance on Helicobacter pylori eradication regimens. J Dig Dis 2022; 23: 561-567
- 14 Malfertheiner P, Bazzoli F, Delchier J-C. et al. Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial. The Lancet 2011; 377: 905-913
- 15 Graham DY, Pina DM, Lu H. Understanding treatment guidelines with bismuth and non-bismuth quadruple Helicobacter pylori eradication therapies. Expert Review of Anti-infective Therapy 2018; 16: 679-687
- 16 Hu J, Mei H, Su NY. et al. Eradication rates of Helicobacter pylori in treatment-naive patients following 14-day vonoprazan-amoxicillin dual therapy: A multicenter randomized controlled trial in China. Helicobacter 2023; 28: e12970
- 17 Antibiotic stewardship-(ABS-) Netzwerk Westfalen-Lippe. Zugriff am 30. April 2025 unter: https://www.uni-bielefeld.de/fakultaeten/gesundheitswissenschaften/ag/ag2/antib/abs-netzwerk-wl/
- 18 Saranathan R, Levi MH, Wattam AR. et al. Helicobacter pylori infections in the Bronx, New York: Surveying antibiotic susceptibility and strain lineage by whole-genome sequencing. J Clin Microbiol 2020; 58
- 19 Marques B, Donato MM, Cardoso O. et al. Study of rdxA and frxA genes mutations in metronidazole-resistant and -susceptible Helicobacter pylori clinical isolates from the central region of Portugal. J Glob Antimicrob Resist 2019; 17: 300-304
- 20 Hulten KG, Genta RM, Kalfus IN. et al. Comparison of culture with antibiogram to next-generation sequencing using bacterial isolates and formalin-fixed, paraffin-embedded gastric biopsies. Gastroenterology 2021; 161: 1433-1442.e1432
- 21 Chey WD, Mégraud F, Laine L. et al. Vonoprazan triple and dual therapy for Helicobacter pylori infection in the United States and Europe: Randomized clinical trial. Gastroenterology 2022; 163: 608-619
- 22 Moss SF, Chey WD, Daniele P. et al. Brief communication: global temporal trends in the efficacy of clarithromycin-based regimens for the treatment of Helicobacter pylori infection. Therap Adv Gastroenterol 2023; 16: 17562848231167284
- 23 Schulz C, Schütte K, Link A. et al. 1983–2023 – Four decades Helicobacter pylori – what's next?. Z Gastroenterol 2024; 62: 512-516
- 24 Garces-Duran R, Kindt S, Kotilea K. et al. Belgian consensus for Helicobacter pylori management 2023. Acta Gastroenterol Belg 2023; 86: 74-91
- 25 Bytzer P, Dahlerup J, Eriksen JR. et al. Helicobacter pylori infektion: Diagnostik og behandling (11/2020). In; 2020.
- 26 Veenendaal RA, Woudt SHS, Schoffelen AF. et al. Important rise in antibiotic resistance rates in Helicobacter pylori in the Netherlands. Ned Tijdschr Geneeskd 2022; 166: D6434
- 27 Blesl A, Constantini-Kump P, Gschwantler M. et al. Helicobacter pylori (H.p.). In: Österreichische Gesellschaft für Gastroenterologie und Hepatologie ed. Graz; 2024.
- 28 Weber R, Fliegner M, Chmiel C. Guideline Helicobacter pylori-Infektion und Ulkuskrankheit (Stand 07/2024). Accessed 15.05.2025.
- 29 Deutsches Register für Klinische Studien (DRKS): Resistenzgerechte Helicobacter pylori Eradikation und Antibiotic Stewardship. Zugriff am 01. Mai 2025 unter: https://drks.de/search/de/trial/DRKS00033330/details