BACKGROUND Helicobacter pylori treatment failure remains a challenging problem. This study aimed to identify predictive factors for successful eradication in patients following treatment failures. METHODS This was a retrospective cohort study. This study included 1,050 dyspeptic patients diagnosed with H. pylori infection at tertiary care center in Thailand between March 2014 and October 2021. Patients' demographic data, endoscopic findings, H. pylori culture, antimicrobial susceptibility testing (AST), treatment regimens and outcomes were analysed. RESULTS Of 1,050 patients with H. pylori infections, 302 (28.7%) experienced treatment failure (mean age 58.4 years; 44.7% males). AST was performed in 192. Resistance was observed for metronidazole (43.2%), levofloxacin (33.9%), clarithromycin (24%), and amoxicillin (2.1%). There was no tetracycline resistance. Multidrug-resistance (MDR) was significantly more common following treatment failure (45.5% vs. 15.7%, p<0.001). Baseline characteristics were similar between treatment successes and failures. Eradication rates after first-line and second-line regimens were 71.2% and 54.5%, respectively. Medication nonadherence [OR 36.6 (95%CI 8.65-155.03, p<0.001)] and MDR [OR 4.49 (95%CI 2.29-8.81, p<0.001)] were associated with treatment failure. Over time, resistance increased for metronidazole, levofloxacin, and clarithromycin, while eradication rates with triple therapy declined. Tailored antibiotic therapy [OR 4.92 (95%CI 1.61-14.99, p = 0.005)] and a regimen including 4-times-daily dosing of amoxicillin (2 grams/day) [OR 3.05 (95%CI 1.10-8.41, p = 0.032)] were significantly associated with treatment success after first-line failure. Eradication rates when using tailored therapy and 4-times-daily dosing of amoxicillin (2 grams/day) were 91.1% and 89.4%, respectively. Performing AST before first-line therapy resulted in the highest cure rates. AST performed after multiple treatment failures was also associated with higher eradication rates compared with the group without AST (94.4% vs. 50%,p = 0.008). CONCLUSIONS AST either before or after treatment failure correlated with a higher proportion of successful eradication. Nonadherence and the MDR infections predicted treatment failure. Tailored therapy and 4-times-daily dosing of amoxicillin after treatment failure were likely to be successful.

中文翻译：

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幽门螺杆菌治疗失败的管理：一项基于大规模人群的研究（幽门螺杆菌治疗失败试验）。

背景幽门螺杆菌治疗失败仍然是一个具有挑战性的问题。本研究旨在确定治疗失败后患者成功根除的预测因素。方法 这是一项回顾性队列研究。该研究纳入了 2014 年 3 月至 2021 年 10 月期间在泰国三级护理中心诊断为幽门螺杆菌感染的 1,050 名消化不良患者。分析了。结果 在 1,050 名幽门螺杆菌感染患者中，302 名 (28.7%) 经历了治疗失败（平均年龄 58.4 岁；44.7% 为男性）。192 例进行了 AST。观察到对甲硝唑（43.2%）、左氧氟沙星（33.9%）、克拉霉素（24%）和阿莫西林（2.1%）的耐药性。不存在四环素耐药性。治疗失败后，多重耐药性 (MDR) 明显更为常见（45.5% vs. 15.7%，p<0.001）。治疗成功和失败的基线特征相似。一线和二线治疗后的根除率分别为 71.2% 和 54.5%。药物不依从性 [OR 36.6 (95% CI 8.65-155.03, p<0.001)] 和 MDR [OR 4.49 (95% CI 2.29-8.81, p<0.001)] 与治疗失败相关。随着时间的推移，甲硝唑、左氧氟沙星和克拉霉素的耐药性增加，而三联疗法的根除率下降。定制抗生素治疗 [OR 4.92 (95%CI 1.61-14.99, p = 0.005)] 和包括每日 4 次阿莫西林给药（2 克/天）的治疗方案 [OR 3.05 (95%CI 1.10-8.41, p = 0.005)] 0.032)]与一线治疗失败后的治疗成功显着相关。使用定制疗法和每天服用 4 次阿莫西林（2 克/天）时的根除率分别为 91.1% 和 89.4%。在一线治疗前进行 AST 治疗的治愈率最高。与未使用 AST 的组相比，多次治疗失败后进行的 AST 也与较高的根除率相关（94.4% vs. 50%，p = 0.008）。结论 治疗失败之前或之后的 AST 与成功根除的比例较高相关。不依从和耐多药感染预示着治疗失败。治疗失败后，量身定制的治疗和每天服用 4 次阿莫西林可能会成功。