1445Antibiotic susceptibility of Helicobacter pylori in Arctic Canadian Indigenous communities

Background Our community-driven projects address concerns of Canadian Arctic Indigenous communities about Helicobacter pylori (Hp) infection, responsible for elevated gastric cancer mortality in the region. A key concern is poor effectiveness of anti-Hp treatment. We aimed to describe antibiotic resistance patterns in Hp isolated from project participants. Methods Participants in 7 communities underwent upper gastrointestinal endoscopy with 2 gastric biopsies taken for tissue culture during 2008-2017. We tested Hp isolates for resistance to 7 antibiotics by Etest and assessed 4 outcomes: resistance to metronidazole, clarithromycin, 1+ antibiotics, and 2+ antibiotics. We tabulated proportion positive among isolates tested with 95% confidence intervals (CI) and used logistic regression to assess the relation of age and sex to resistance outcomes. Results Of 259 Hp isolates tested, resistance to metronidazole, clarithromycin, 1+ antibiotics, and 2+ antibiotics were (% [CI]): respectively, 35 [29-41], 19 [15-25], 44 [38-50], and 12 [8-17] overall; 38 [30-47], 24 [17-32], 49 [41-58], and 16 [11-23] in 146 isolates from women; and 30 [22-39], 13 [8-21], 36 [27-46], and 6 [3-12] in 113 isolates from men. Odds of resistance to clarithromycin, 1+ antibiotics, 2+ antibiotics, and, to a lesser degree metronidazole, were elevated in women relative to men after age adjustment and increased with age in women but not men. Conclusion In Arctic Indigenous communities in Canada, women were more likely than men to harbor antibiotic-resistant Hp, and their frequency of resistant Hp infection increased with age. Key messages Community-driven research answers questions posed by those who bear the disease burden.