{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T08:07:39Z","timestamp":1770883659433,"version":"3.50.1"},"reference-count":50,"publisher":"Akademiai Kiado Zrt.","issue":"1","funder":[{"name":"Medical University of Sofia","award":["D-118 \/04.06.2021"],"award-info":[{"award-number":["D-118 \/04.06.2021"]}]},{"name":"Medical University of Sofia","award":["7914 \/ 19.11.2020"],"award-info":[{"award-number":["7914 \/ 19.11.2020"]}]}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMicr"],"published-print":{"date-parts":[[2022,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Antibiotic resistance of<jats:italic>Helicobacter pylori<\/jats:italic>strains from 106 symptomatic children was evaluated according to EUCAST breakpoints and rate of multidrug resistance (MDR) was analyzed. Overall resistance rates were amoxicillin 7.5%, metronidazole 25.5%, clarithromycin 34.0% and ciprofloxacin 14.1%. There were no significant differences in resistance rates according to patients' age (2\u20136 and 7\u201318 years) and sex. Combined resistance rate was 19.8%, including double, triple, and quadruple resistance in 13.2% (14 strains), 5.7% (6) and 0.9% (1) of the strains, respectively. MDR was found in 5.9% (5\/84) of the children with gastritis and in two of the four children with celiac disease. The MDR was present in three children aged 4\u20136 years and in four children aged 10\u201317 years. The total MDR rate (6.6%) in Bulgarian children in 2012\u20132021 was higher than those in other studies based on EUCAST breakpoints such as those in pediatric patients in Slovenia in 2011\u20132014 (3.8%), Lithuania in 2013\u20132015 (0%) and Spain in 2014\u20132019 (0%), although being lower than those (20.7% in the untreated and 47.0% in the treated children) in China in 2019. In brief, it is of concern that MDR can strongly limit the choice of<jats:italic>H. pylori<\/jats:italic>therapy of one out of fifteen Bulgarian children and that overall resistance to both metronidazole and clarithromycin can hinder the treatment of 15.1% of the pediatric patients. Susceptibility-guided tailored eradication therapy of<jats:italic>H. pylori<\/jats:italic>infection should be more frequently implemented in the symptomatic children to avoid risks of both the infection itself and multiple antibiotic treatments.<\/jats:p>","DOI":"10.1556\/030.2022.01682","type":"journal-article","created":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T12:20:57Z","timestamp":1643804457000},"page":"41-45","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.1","source":"Crossref","is-referenced-by-count":6,"title":["Investigation of multidrug-resistant Helicobacter pylori in pediatric patients: A Bulgarian study and literature data"],"prefix":"10.1556","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9622-0873","authenticated-orcid":true,"given":"Lyudmila","family":"Boyanova","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petyo","family":"Hadzhiyski","sequence":"additional","affiliation":[{"name":"Specialized Hospital for Active Pediatric Treatment, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rumyana","family":"Markovska","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raina","family":"Gergova","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"ref261","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1053\/j.gastro.2017.04.022","article-title":"Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis","volume":"153","author":"Hooi","year":"2017","journal-title":"Gastroenterology"},{"key":"ref481","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/MPG.0b013e3181fc8c58","article-title":"ESPGHAN Working Group on Helicobacter pylori infection. 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