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Volume 10, Number 6—June 2004

Research

Antimicrobial Resistance Incidence and Risk Factors among Helicobacter pylori–Infected Persons, United States

William M. Duck*, Jeremy Sobel*, Janet M. Pruckler*, Qunsheng Song*, David Swerdlow*, Cindy Friedman*, Alana Sulka*, Balasubra Swaminathan*, Tom Taylor*, Mike Hoekstra*, Patricia M. Griffin*, Duane Smoot†, Rick Peek‡, DavidC. Metz§, Peter B. Bloom¶, Steven Goldschmid¶, Julie Parsonnet#, George Triadafilopoulos#, Guillermo I. Perez-Perez**, Nimish Vakil††, Peter Ernst‡‡, Steve Czinn§§, Donald Dunne§§, and Ben D. Gold*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Howard University Medical Center, Washington, DC, USA; ‡Vanderbilt University Medical Center, Nashville, Tennessee, USA; §University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA; ¶Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA; #Stanford University Medical Center, Palo Alto, California, USA; **New York University School of Medicine, New York, New York, USA; ††Sinai Samaritan Medical Center, Milwaukee, Wisconsin, USA; ‡‡University of Virginia, Charlottesville, Virginia, USA; §§University Hospitals of Cleveland, Cleveland, Ohio, USA; ¶¶Indiana University Medical Center, Indianapolis, Indiana, USA

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Table 4

Univariate analysis of risk factors for resistance to >1 antimicrobial agent among Helicobacter pylori isolates submitted to HARP, 1998–2002

Risk factor Proportion of patients harboring resistant H. pylori isolate
Odds ratio (95% CI)
Exposed, n (%) Unexposed, n (%)
Zantac use 12 mo before EGD
25 (48)
89 (32)
2.0 (1.1–3.6)b
Tums use 12 mo before EGD
19 (51)
95 (32)
2.2 (1.1–4.4)b
Tums use 30 d before EGD
12 (55)
102 (33)
2.4 (>1.0–5.8)b
Mylanta use 12 mo before EGD
4 (15)
110 (36)
0.3 (0.1–1.0)
Took antibiotic 12 mo before EGD
29 (43)
68 (34)
1.5 (0.9–2.6)
Past treatment of H. pylori infection with:



PPI
5 (71)
109 (34)
4.9 (1.0–26)
Clarithromycin
5 (83)
109 (33)
9.9 (1.1–86)
Treatment for H. pylori a second time in the past 5 years
11 (65)
107 (32)
3.8 (1.4–11)
Treatment of H. pylori infection more than once with



PPI
8 (80)
106 (33)
8.1 (1.7–39)
Clarithromycin
8 (80)
106 (33)
8.1 (1.7–39)
Age >57 years
50 (31)
68 (37)
0.8 (0.5–1.2)
Race/ethnicity



Black
67 (39)
51 (29)
1.6 (1.0–2.4)
Hispanic
2 (11)
116 (35)
0.2 (0.1–1.0)
Male sex
65 (31)
47 (42)
0.6 (0.4–1.0)
HARP site



New York, NY
3 (14)
115 (35)
0.3 (0.1–1.0)
Palo Alto, CA
4 (17)
114 (35)
0.4 (0.1–1.1)
Atlanta, GA
8 (22)
110 (36)
0.5 (0.2–1.1)
Nashville, TN 11 (24) 107 (35) 0.6 (0.3–1.2)

aN = 347; HARP, Helicobacter pylori Antimicrobial Resistance Monitoring Project; EGD, esophagogastro-duodenal endoscopy; PPI, proton pump inhibitor; CI, confidence interval.
bThese risk factors were not considered for multivariate analysis because of small cell-size differences between subjects with a resistant H. pylori infection and those without.

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