PMID- 38276175 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240129 IS - 2076-2607 (Print) IS - 2076-2607 (Electronic) IS - 2076-2607 (Linking) VI - 12 IP - 1 DP - 2023 Dec 19 TI - Independent Risk Factors Predicting Eradication Failure of Hybrid Therapy for the First-Line Treatment of Helicobacter pylori Infection. LID - 10.3390/microorganisms12010006 [doi] LID - 6 AB - Hybrid therapy is a recommended first-line anti-H. pylori treatment option in the American College of Gastroenterology guidelines, the Bangkok Consensus Report on H. pylori management, and the Taiwan H. pylori Consensus Report. However, the cure rates of eradication therapy in some countries are suboptimal, and the factors affecting the treatment efficacy of hybrid therapy remain unclear. The aim of this study is to identify the independent risk factors predicting eradication failure of hybrid therapy in the first-line treatment of H. pylori infection. A retrospective cohort study was conducted on 589 H. pylori-infected patients who received 14-day hybrid therapy between September 2008 and December 2021 in ten hospitals in Taiwan. The patients received a hybrid therapy containing a dual regimen with a proton pump inhibitor (PPI) plus amoxicillin for an initial 7 days and a quadruple regimen with a PPI plus amoxicillin, metronidazole and clarithromycin for a final 7 days. Post-treatment H. pylori status was assessed at least 4 weeks after completion of treatment. The relationships between eradication rate and 13 host and bacterial factors were investigated via univariate and multivariate analyses. In total, 589 patients infected with H. pylori infection were included in the study. The eradication rates of hybrid therapy were determined as 93.0% (95% confidence interval (CI): 90.9-95.1%), 94.4% (95% CI: 93.8-97.2%) and 95.5%% (95% CI: 93.8-97.2%) by intention-to-treat, modified intention-to-treat and per-protocol analyses, respectively. Univariate analysis showed that the eradication rate of clarithromycin-resistant strains was lower than that of clarithromcyin-susceptible strains (83.3% (45/54) vs. 97.6%% (280/287); p < 0.001). Subjects with poor drug adherence had a lower cure rate than those with good adherence (73.3% (11/15) vs. 95.5% (534/559); p = 0.005). Other factors such as smoking, alcohol drinking, coffee consumption, tea consumption and type of PPI were not significantly associated with cure rate. Multivariate analysis revealed that clarithromcyin resistance of H. pylori and poor drug adherence were independent risk factors related to eradication failure of hybrid therapy with odds ratios of 4.8 (95% CI: 1.5 to 16.1; p = 0.009) and 8.2 (95% CI: 1.5 to 43.5; p = 0.013), respectively. A 14-day hybrid therapy has a high eradication rate for H. pylori infection in Taiwan, while clarithromycin resistance of H. pylori and poor drug adherence are independent risk factors predicting eradication failure of hybrid therapy. FAU - Chen, Chien-Lin AU - Chen CL AUID- ORCID: 0000-0002-9084-8210 AD - Department of Medicine, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien 970, Taiwan. FAU - Wu, I-Ting AU - Wu IT AD - Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan 709, Taiwan. FAU - Wu, Deng-Chyang AU - Wu DC AD - Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan. FAU - Lei, Wei-Yi AU - Lei WY AD - Department of Medicine, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien 970, Taiwan. FAU - Tsay, Feng-Woei AU - Tsay FW AD - Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung 813, Taiwan. FAU - Chuah, Seng-Kee AU - Chuah SK AUID- ORCID: 0000-0002-8934-3223 AD - Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan. FAU - Chen, Kuan-Yang AU - Chen KY AD - Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital, Renai Branch, Taipei 106, Taiwan. FAU - Yang, Jyh-Chin AU - Yang JC AD - Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan. FAU - Liu, Yu-Hwa AU - Liu YH AD - Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Huo-Shih Memorial Hospital, Taipei 111, Taiwan. FAU - Kuo, Chao-Hung AU - Kuo CH AD - Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan. FAU - Shiu, Sz-Iuan AU - Shiu SI AD - Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan. FAU - Shie, Chang-Bih AU - Shie CB AD - Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan 709, Taiwan. FAU - Lin, Kuan-Hua AU - Lin KH AD - Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan 709, Taiwan. FAU - Lee, Chia-Long AU - Lee CL AUID- ORCID: 0000-0001-8556-024X AD - Division of Gastroenterology and Hepatology, Department of Internal Medicine Cathay General Hospital, Taipei 106, Taiwan. FAU - Hsu, Ping-I AU - Hsu PI AUID- ORCID: 0000-0003-3905-4674 AD - Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan 709, Taiwan. LA - eng GR - ANHRF111-33, ANHRF112-09 and ANHRF 112-45/Research Foundation of An Nan Hospital, China Medical University/ PT - Journal Article DEP - 20231219 PL - Switzerland TA - Microorganisms JT - Microorganisms JID - 101625893 PMC - PMC10820614 OTO - NOTNLM OT - Helicobacter pylori OT - eradication failure OT - hybrid therapy OT - resistance OT - risk factors COIS- The authors declare no conflict of interest. EDAT- 2024/01/26 12:45 MHDA- 2024/01/26 12:46 PMCR- 2023/12/19 CRDT- 2024/01/26 09:25 PHST- 2023/11/01 00:00 [received] PHST- 2023/12/10 00:00 [revised] PHST- 2023/12/12 00:00 [accepted] PHST- 2024/01/26 12:46 [medline] PHST- 2024/01/26 12:45 [pubmed] PHST- 2024/01/26 09:25 [entrez] PHST- 2023/12/19 00:00 [pmc-release] AID - microorganisms12010006 [pii] AID - microorganisms-12-00006 [pii] AID - 10.3390/microorganisms12010006 [doi] PST - epublish SO - Microorganisms. 2023 Dec 19;12(1):6. doi: 10.3390/microorganisms12010006.