Accuracy of various diagnostic tests and antimicrobial sensitivity pattern of Helicobacter pylori infection in a tertiary care centre in Nepal

Abstract

Introduction: Helicobacter pylori infection is the most important cause of peptic ulcer disease as well as other gastrointestinal conditions. Most widely used diagnostic tests for detection of Helicobacter pylori include rapid urease test, histopathology, culture/sensitivity and serology. The objective of this study was to determine accuracy of standard diagnostic tests and the prevailing local antibiotic susceptibility patterns.

Methods: This cross sectional study, conducted from May to October 2009 at Tribhuvan University Teaching Hospital. 3 pieces of biopsy pieces were obtained from the antral mucosa which were subsequently used for Rapid Urease Test (RUT), histopathology and culture/sensitivity. Then, 2 ml of venous blood was drawn from the antecubital vein for serological examination.

Results: H. pylori positivity status was reflected as 32%, 32% and 47% by rapid urease test, culture and histology. The seroprevalence of H. pylori was 63%. A patient was considered to be positive with respect to H. pylori infection when at least two of three tests namely rapid urease test, culture and histology gave positive results. Hence, proportion of patients with positive H. pylori infection was 36%. Only 30 from 32 culture positive cases were efficiently subcultured and further processed for antibiotic susceptibility testing. Resistance to metronidazole was found to be the highest securing 53.3% and lowest to levofloxacin (0%).

Conclusions: Detection of Helicobacter pylori infection using serology was the most effective among the diagnostic tests performed. More than half of the patients were resistant metronidazole while levofloxacin was sensitive in all the cases.