ABSTRACT Background European guidelines recommend that susceptibility tests be routinely performed, even before prescribing first‐line treatment of Helicobacter pylori infection. However, empirical treatments are the rule in France, and susceptibility‐guided treatments are the exception. Objective We aimed to report our experience of systematic antibiotic susceptibility testing before first‐line treatment. Methods Prospective registration of all esofagogastroduodenoscopies performed in a community hospital from December 2023 to December 2024. Antral and fundic biopsies were performed, at the discretion of the endoscopist, for histological examination, polymerase chain reaction (PCR) and culture without any freezing. Results Overall, 3566 adults underwent esofagogastroduodenoscopy, 1785 (50.1%) were tested and H. pylori infection was diagnosed in 308 (17.3%) [95% confidence interval (CI): 15.5%–19.0%] individuals. The sensitivity of PCR for the diagnosis of H. pylori infection was 99.7%, significantly higher than those of histology (94.1%) and culture (95.2%) ( p < 0.01). Clarithromycin resistance was observed in 22.6% [95% CI: 17.9%–27.3%] and levofloxacin resistance in 18.6% [95% CI: 14.1%–23.2%] of cases. Among 285 patients treated, susceptibility‐guided triple therapy was prescribed in 84.9% of cases (73.3% amoxicillin‐clarithromycin, 11.6% amoxicillin‐levofloxacin) and quadruple bismuth therapy in 14.4% of cases. The eradication rates were 98.1% [95% CI: 96.0%–100%] for triple therapy amoxicillin‐clarithromycin and 100% [95% CI: 100%–100%] for amoxicillin‐levofloxacin, significantly higher than 81.3% [95% CI: 67.7%–94.8%] for quadruple bismuth therapy ( p < 0.01 and p = 0.03, respectively). Overall, of 218 (70.8%) patients evaluated by the C13 urea breath test, H. pylori was eradicated in 209 (95.9%) [95% CI: 93.2%–98.5%] patients. The PCR‐based diagnostic and therapeutic strategy was more cost‐effective than the immunohistochemistry‐based strategy. Conclusion A PCR‐based susceptibility‐guided strategy is easy to implement in routine clinical practice. In more than 7 in 10 patients, PCR enabled the offer of a susceptibility‐guided triple therapy that was more effective and less costly than empirical quadruple bismuth therapy. Culture enabled one additional patient in 10 to be offered a susceptibility‐guided triple therapy.
ABSTRACT Birds of prey are renowned for their excellent visual acuity, but they are often not given visual access consistent with their natural behavior when housed under managed care. Often, these birds are housed under managed care after sustaining injuries, which prohibits their return to the wild. In addition, many of these rescued raptors do not have the same history of acclimation to human presence as other zoo animals due to being wild‐hatched. These factors lead to a potential welfare concern for raptors under managed care, which may not appropriately address their natural and individual histories. We assessed how the removal of a visual barrier (two large doors) may have affected behavior and space use of two bald eagles ( Haliaeetus leucocephalus ) housed at Zoo Miami. Before the visual barrier being removed, the eagles could not see people approaching their habitat from one out of two possible sides. We found that for one individual, stress behaviors such as gular fluttering significantly decreased after the removal of the visual barrier, and resting significantly increased. The birds also utilized their habitat more evenly after the visual barrier was removed and were seen at higher, more species‐typical altitudes within the habitat. These findings suggest that increased environmental visual access for zoo‐housed raptors may be a simple way to improve their overall welfare.