1
|
Liu DS, Wang YH, Zhu ZH, Zhang SH, Zhu X, Wan JH, Lu NH, Xie Y. Characteristics of Helicobacter pylori antibiotic resistance: data from four different populations. Antimicrob Resist Infect Control 2019; 8:192. [PMID: 31798838 PMCID: PMC6882003 DOI: 10.1186/s13756-019-0632-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022] Open
Abstract
Aims To describe the characteristics of Helicobacter pylori (H. pylori) antibiotic resistance in clinical isolates from four populations. Methods In total, 1463 H. pylori strains were examined for antibiotic resistance. Among these strains, 804 were isolated from treatment-naïve adults, 133 from previously treated adults, 100 from treatment-naïve children and 426 from a population who participated in a health survey (age ≥ 40 years). The minimum inhibitory concentration was determined by the E-test method. Results In the treatment-naïve adult group, the resistance rates for metronidazole, clarithromycin, levofloxacin, amoxicillin, rifampicin and tetracycline were 78.4, 19.0, 23.3, 1.2, 1.7 and 2.3%, respectively. Compared with this group, the previously treated adult group had significantly higher resistance rates for metronidazole (99.2%), clarithromycin (58.3%) and levofloxacin (52.3%). In addition, the treatment-naïve children had a lower metronidazole resistance rate (46.0%) than the treatment-naïve adults. The resistance rate for clarithromycin was low in treatment-naïve patients with ages ranging from 10 to 24 years. For the strains isolated from the general population group, the resistance rates for metronidazole, clarithromycin, levofloxacin, amoxicillin, rifampicin and tetracycline were 78.6, 10.1, 25.1, 0.5, 2.1 and 0.9%, respectively. Compared with the treatment-naïve adult group, the general population group showed significant differences in clarithromycin resistance. Conclusion The resistance rates for metronidazole, clarithromycin and levofloxacin were high, especially in previously treated adults. Compared to those in treatment-naïve younger patients, the resistance rates for clarithromycin were significantly lower in treatment-naïve patients with ages ranging from 10 to 24 years and in the general population.
Collapse
Affiliation(s)
- Dong-Sheng Liu
- 1Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province China
| | - You-Hua Wang
- 1Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province China
| | - Zhen-Hua Zhu
- 1Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province China
| | - Shuang-Hong Zhang
- 1Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province China.,Department of Gastroenterology, Children's Hospital of Jiangxi, Nanchang, Jiangxi Province China
| | - Xuan Zhu
- 1Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province China
| | - Jian-Hua Wan
- 1Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province China
| | - Nong-Hua Lu
- 1Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province China
| | - Yong Xie
- 1Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province China
| |
Collapse
|
2
|
Butenko T, Jeverica S, Orel R, Homan M. Antibacterial resistance and the success of tailored triple therapy in Helicobacter pylori strains isolated from Slovenian children. Helicobacter 2017; 22:e12400. [PMID: 28653787 PMCID: PMC5637919 DOI: 10.1111/hel.12400] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary Helicobacter pylori (H. pylori) infection occurs predominantly in childhood. Antimicrobial resistance is the leading cause for H. pylori eradication failure. The aims of this study were (i) to establish for the first time the antimicrobial resistance of H. pylori strains in infected Slovenian children not previously treated for H. pylori infection and (ii) to evaluate the effectiveness of tailored triple therapy, assuming that eradication rate with tailored triple therapy will be >90%. METHODS Data on all treatment-naive children 1-18 years old and treated for H. pylori infection according to susceptibility testing were retrospectively analyzed. All relevant clinical information and demographical information were retrospectively collected from the hospital information systems and/or patients' medical documentation. RESULTS The inclusion criteria were met by 107 children (64.5% girls) with a median age of 12.0 years (range 2.0-17.6 years). Primary antimicrobial resistance rates of H. pylori were 1.0% to amoxicillin (AMO), 23.4% to clarithromycin (CLA), 20.2% to metronidazole (MET), 2.8% to levofloxacin (LEV), and 0.0% to tetracycline (TET). Dual resistances were detected to CLA and MET in 11.5% (n=12) of strains, to CLA and LEV in 2.8% (n=3), and to MET and LEV in 2.9% (n=3). Results of treatment success were available for 71 patients (66.2% girls). Eradication of H. pylori was evaluated using the 13C-urea breath test, monoclonal stool antigen test or in some cases with repeated upper GI endoscopy with histology and cultivation/molecular tests. Eradication was achieved in 61 of 71 (85.9%) patients. CONCLUSIONS The primary resistance rates of H. pylori to CLA and MET in Slovenia are high. Our data strongly support the fact that in countries with high prevalence of resistant H. pylori strains susceptibility testing and tailored therapy is essential.
Collapse
Affiliation(s)
- Tita Butenko
- Department of Gastroenterology, Hepatology, and NutritionUniversity Children's HospitalLjubljanaSlovenia
| | - Samo Jeverica
- Faculty of MedicineInstitute of Microbiology and ImmunologyUniversity of LjubljanaLjubljanaSlovenia
| | - Rok Orel
- Department of Gastroenterology, Hepatology, and NutritionUniversity Children's HospitalLjubljanaSlovenia
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology, and NutritionUniversity Children's HospitalLjubljanaSlovenia
| |
Collapse
|
3
|
Keshavarz Azizi Raftar S, Moniri R, Saffari M, Razavi Zadeh M, Arj A, Mousavi SGA, Mirzaei Ghazi Kalayeh H, Dastehgoli K. The Helicobacter pylori resistance rate to clarithromycin in Iran. Microb Drug Resist 2014; 21:69-73. [PMID: 25144338 DOI: 10.1089/mdr.2014.0104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clarithromycin is the most commonly suggested antibiotic in Helicobacter pylori eradication regimens. Increasing antibiotic resistance rate to clarithromycin is the main reason for therapeutic failure. The resistance is associated with mutations in the 23S rRNA gene. AIM The purpose of this study was to determine the clarithromycin resistance rate of isolated H. pylori strains from referral patients in Kashan, Iran. METHODS In total 95 H. pylori strains isolated from gastric mucosa of 246 patients with different clinical signs underwent gastroscopy in Kashan, Iran in 2013. The Epsilometer test was used to determine the minimum inhibitory concentrations (MICs) of clarithromycin (CLR) in isolated H. pylori strains. Occurrence of mutation in 23S rRNA gene of clarithromycin-resistant strains was investigated with polymerase chain reaction-sequencing method. RESULTS Antibiotic susceptibility pattern showed that 32 strains (33.7%) were resistant to clarithromycin (MICs ≥1 μg/ml), 33.7% were intermediate resistant, while 31 of H. pylori strains (32.6%) were susceptible. The 23S rRNA gene mutations at positions A2143G and A2142G were detected in H. pylori clarithromycin-resistant strains. CONCLUSION The resistance rate to clarithromycin in Iran is high. H. pylori clarithromycin-resistant strains were not associated with sex, age, and disease. The A2143G mutation in clarithromycin-resistant H. pylori strains was the predominant finding.
Collapse
|
4
|
Keshavarz Azizi Raftar S, Moniri R, Saffari M, Zadeh MR, Arj A, Abbas Moosavi SG, Ghazi Kalayeh HM. Helicobacter pylori resistance to ciprofloxacin in Iran. Int J Antimicrob Agents 2014; 43:573-4. [DOI: 10.1016/j.ijantimicag.2014.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 01/10/2023]
|
5
|
Seo JH, Woo HO, Youn HS, Rhee KH. Antibiotics resistance of Helicobacter pylori and treatment modalities in children with H. pylori infection. KOREAN JOURNAL OF PEDIATRICS 2014; 57:67-71. [PMID: 24678329 PMCID: PMC3965796 DOI: 10.3345/kjp.2014.57.2.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/24/2014] [Indexed: 01/23/2023]
Abstract
Pediatric infection with Helicobacter pylori may occur early in childhood and persist lifelong. Global pediatric clinical studies have reported a decreasing tendency in the overall rate of H. pylori eradication. In pediatric patients with H. pylori infection, pediatric patients with peptic ulcer, and the first-degree relatives of patients with a history of gastric cancer, it is commonly recommended that H. pylori strains be eradicated. Antibiotic drug resistance to H. pylori, which has been reported to vary widely between geographic regions, is mainly associated with treatment failure in these patients. It is therefore imperative that the antibiotic resistance rates of H. pylori in children and adolescents be meticulously monitored across countries and throughout geographic regions. This paper particularly focuses on the antibiotic drug resistance of H. pylori and the thearpy of pediatric H. pylori infection cases.
Collapse
Affiliation(s)
- Ji-Hyun Seo
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Hee-Shang Youn
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Kwang-Ho Rhee
- Department of Microbiology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| |
Collapse
|
6
|
Chisholm SA, Owen RJ. From Nobel to no cure: a case for monitoring antibiotic resistance in the gastric pathogenHelicobacter pylori. Expert Rev Anti Infect Ther 2014; 4:349-51. [PMID: 16771610 DOI: 10.1586/14787210.4.3.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Selgrad M, Bornschein J, Malfertheiner P. Guidelines for treatment of Helicobacter pylori in the East and West. Expert Rev Anti Infect Ther 2013; 9:581-8. [PMID: 21819326 DOI: 10.1586/eri.11.80] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Infection with Helicobacter pylori remains a major healthcare burden, with persistently high prevalence rates, especially in less-developed countries. H. pylori infection is causally related to non-malignant and malignant gastroduodenal diseases, such as peptic ulcer diseases, gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. Current international guidelines recommend a standard triple therapy as first-line therapy, including a proton pump inhibitor and a combination of amoxicillin and clarithromycin. Standard triple therapy has shown a decreasing efficacy over the years. The main reason is the increasing antibiotic resistance, particular to clarithromycin of H. pylori strains. Several new treatment options or modifications of already established regimens have been introduced to overcome treatment failure. In this article, we intend to report the reasons for treatment failure, and furthermore we give an overview of new treatment options as alternatives to the current treatment regimens. Finally, the strategy for the future is considered.
Collapse
Affiliation(s)
- Michael Selgrad
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | | | | |
Collapse
|
8
|
High Helicobacter pylori resistance to metronidazole and clarithromycin in Brazilian children and adolescents. J Pediatr Gastroenterol Nutr 2013; 56:645-8. [PMID: 23403439 DOI: 10.1097/mpg.0b013e31828b3669] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of the present study was to assess the primary and secondary resistance of Helicobacter pylori strains to clarithromycin, amoxicillin, furazolidone, tetracycline, and metronidazole, the conventional antibiotics presently used in Brazilian children and adolescents. METHODS Seventy-seven consecutive H pylori strains, 71 of 77 strains obtained from patients without previous eradication treatment for H pylori infection, and 6 strains from patients in whom previous eradication treatment had failed. RESULTS Global rate of resistance was 49.3% (38/77): 40% of strains were resistant to metronidazole, 19.5% to clarithromycin, and 10.4% to amoxicillin. All of the tested H pylori strains were susceptible to furazolidone and tetracycline. Multiple resistance were detected in 18.2% (14/77 patients) of the strains: 6 of 14 (43%) simultaneously resistant to clarithromycin and metronidazole; 5 of 14 (36%) to amoxicillin and metronidazole; 2 of 14 (14%) to amoxicillin, clarithromycin, and metronidazole; and 1 of 14 (7%) to clarithromycin and amoxicillin. CONCLUSIONS The high resistance rate to metronidazole and clarithromycin observed in clinical H pylori isolates can exclude these antimicrobials in empirical eradication treatment in Brazil. Otherwise, furazolidone and tetracycline presented no resistance. Properly assessing the risks and benefits, these 2 antimicrobials and their derivatives could be used in empirical eradication schedules, both associated with amoxicillin, which showed a low resistance rate despite its wide use in pediatric patients.
Collapse
|
9
|
Lee JW, Kim N, Kim JM, Nam RH, Chang H, Kim JY, Shin CM, Park YS, Lee DH, Jung HC. Prevalence of primary and secondary antimicrobial resistance of Helicobacter pylori in Korea from 2003 through 2012. Helicobacter 2013; 18:206-14. [PMID: 23241101 DOI: 10.1111/hel.12031] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Antimicrobial resistance of Helicobacter pylori (H. pylori) affects the efficacy of eradication therapy. The aim of this study was to estimate the prevalence of primary and secondary resistance of H. pylori isolates to antibiotics and to characterize the risk factors associated with antimicrobial resistance in Korea. MATERIALS AND METHODS This study was performed during the period of 2003-2012. Primary resistance was evaluated from 347 patients without any history of eradication, and secondary resistance was evaluated in 86 patients from whom H. pylori was cultured after failure of eradication. Minimal inhibitory concentration test was performed for amoxicillin, clarithromycin, metronidazole, tetracycline, azithromycin, levofloxacin, and moxifloxacin using agar dilution method. Primary and secondary resistance rates of H. pylori to 7 antibiotics were evaluated and risk factors for the antibiotic resistance were analyzed. RESULTS Increase in the primary resistance rate was found in amoxicillin (6.3-14.9%, p = .051), clarithromycin (17.2-23.7%, p = .323), and both of levofloxacin and moxifloxacin (4.7-28.1%, p = .002) during the study period. Secondary resistance rate significantly increased in metronidazole, levofloxacin, and moxifloxacin. Increase of resistance occurred after initial failure of eradication therapy in case of clarithromycin (p < .001), azithromycin (p < .001), levofloxacin (p = .011), and moxifloxacin (p = .020). Multivariable analyses showed that clarithromycin, azithromycin, levofloxacin, and moxifloxacin resistance was associated with previous eradication treatment history. CONCLUSIONS The increased primary and secondary antibiotic resistance of H. pylori in Korea is ongoing, and it will become a significant limitation for effective eradication of H. pylori in the future.
Collapse
Affiliation(s)
- Jung Won Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Boyanova L, Ilieva J, Gergova G, Evstatiev I, Nikolov R, Mitov I. Living in Sofia is associated with a risk for antibiotic resistance in Helicobacter pylori: a Bulgarian study. Folia Microbiol (Praha) 2013; 58:587-91. [PMID: 23580173 DOI: 10.1007/s12223-013-0251-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 03/28/2013] [Indexed: 12/11/2022]
Abstract
The aim of the retrospective study was to evaluate geographic regions and residence places as possible risk factors for primary Helicobacter pylori antibiotic resistance in Bulgaria. Data from Sofia region, exhibiting the highest living density, were compared to those from other residence places. In total, 588 H. pylori strains from untreated adults who filled a questionnaire were evaluated. Strain susceptibility was assessed by a breakpoint susceptibility test. Resistance rates to metronidazole and clarithromycin have been found to increase, and that to tetracycline has been found to decrease over years. Clarithromycin resistance was 1.7-fold higher in Sofia inhabitants (23.5 %) than elsewhere (13.8 %) and 4.7-fold higher than that in villages (5.0 %). Moreover, the clarithromycin resistance rate was 2.6-fold lower in northern region (8.2 %) than in southern region (21.7 %). On multivariate analysis, sex and residence place were independent predictors for metronidazole resistance. Men were at lower risk for metronidazole resistance compared with women [odds ratio (OR) 0.703; 95 % confidence interval (CI) 0.499-0.990]. Importantly, Sofia inhabitants were at higher risk for the resistance compared with those living elsewhere (OR 1.453; 95 % CI 1.009-2.093). In conclusion, living in Sofia was associated with a risk for antibiotic resistance in H. pylori-positive adults. Living density could be associated with H. pylori resistance rates.
Collapse
Affiliation(s)
- Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Zdrave Street 2, 1431, Sofia, Bulgaria,
| | | | | | | | | | | |
Collapse
|
11
|
Xiong LJ, Tong Y, Wang Z, Mao M. Detection of clarithromycin-resistant Helicobacter pylori by stool PCR in children: a comprehensive review of literature. Helicobacter 2013; 18:89-101. [PMID: 23067446 DOI: 10.1111/hel.12016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Helicobacter pylori infection is acquired mainly during childhood. To eradicate H. pylori, clarithromycin-based triple therapy has been recommended in children and adults by the latest Maastricht Consensus. However, the prevalence of clarithromycin-resistant H. pylori was higher in children than that in adults. Therefore, rapid, reliable and noninvasive methods for detecting clarithromycin-resistant H. pylori strains should be developed for children. MATERIALS AND METHODS Studies on evaluating stool PCR in detecting clarithromycin-resistant H. pylori and epidemiological surveys of the prevalence of clarithromycin-resistant H. pylori in children were searched in PubMed (from 1966 to December, 2011) for reviewing. RESULTS The average rates of primary clarithromycin-resistant H. pylori ranged from less than 10% to more than 40% in different regions. The rates of secondary resistance to clarithromycin were higher than primary resistance in the same population. In H. pylori isolated from children, the frequent point mutations that are responsible for the clarithromycin resistance included A2143G, A2142G, A2142C and A2144G, and they varied geographically. Comparing with culture-based susceptibility tests, stool PCR performed excellently for their rapidity, independence of bacterial growth, reproducibility and easy standardization. However, stool PCR showed lower sensitivity but perfect specificity in detection of clarithromycin-resistant H. pylori in children. Methodology and mixed infections of resistant H. pylori strains might contribute to the considerable discrepancies of stool PCR results. CONCLUSION Detection of clarithromycin-resistant H. pylori by stool PCR for children are reliable, rapid, noninvasive methods that are worthy of further clinical promotion. However, more evaluations of stool PCR in detection of clarithromycin-resistant H. pylori in children need to be conducted.
Collapse
Affiliation(s)
- Li Jing Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | | | | | | |
Collapse
|
12
|
Talebi Bezmin Abadi A, Ghasemzadeh A, Taghvaei T, Mobarez AM. Primary resistance of Helicobacter pylori to levofloxacin and moxifloxacine in Iran. Intern Emerg Med 2012; 7:447-52. [PMID: 21437583 DOI: 10.1007/s11739-011-0563-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 03/10/2011] [Indexed: 01/01/2023]
Abstract
The increase in the prevalence of antibiotic resistance in Helicobacter pylori had a drastic effect on successful treatment. Up-to-date information on H. pylori antibiotic therapy in Iran is still limited. In this study, we aim to determine the prevalence of antibiotic resistance among the H. pylori strains. Furthermore, the possibility of using fluoroquinolones for antibiotic treatment was investigated. Antral biopsy specimens obtained from dyspeptic patients were investigated for H. pylori. Bacterial culture and susceptibility tests were done based on standard methods. H. pylori ATCC 43504 was used as a quality control. In the current study, 30 H. pylori strains were selected randomly and retested to confirm our susceptibility tests. Of 170 patients, 150 were identified as positive for H. pylori (88.2%). In this study, 150 single colonies of H. pylori strains [81 women (54%), 69 men (46%); mean age 38.6; aged 21-70 years] were collected. Primary resistance of H. pylori isolates were clarithromycin (34%), metronidazole (78.6%), tetracycline (9.3%), amoxicillin (10%), levofloxacin (5.3%) and moxifloxacine (4.6%). In conclusion, our results show that we are confronting a new generation of resistant strains of H. pylori in Iran. This alarming finding indicates an urgent need for introduction of new effective antibiotics in our country. Since the majority of clinicians prefer to continue with the ineffective antibiotics as therapeutic regimens, they must also be prepared to deal with treatment failures.
Collapse
Affiliation(s)
- Amin Talebi Bezmin Abadi
- Department of Bacteriology, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | | | | |
Collapse
|
13
|
Alaska sentinel surveillance study of Helicobacter pylori isolates from Alaska Native persons from 2000 to 2008. J Clin Microbiol 2011; 49:3638-43. [PMID: 21813726 DOI: 10.1128/jcm.01067-11] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Helicobacter pylori infection is more common in Alaska Native persons than in the general U.S. population, with seroprevalence to H. pylori approaching 75%. Previous studies in Alaska have demonstrated elevated proportions of antimicrobial resistance among H. pylori isolates. We analyzed H. pylori data from the Centers for Disease Control and Prevention's sentinel surveillance in Alaska from January 2000 to December 2008 to determine the proportion of culture-positive biopsy specimens with antimicrobial resistance from Alaska Native persons undergoing endoscopy. The aim of the present study was to monitor antimicrobial resistance of H. pylori isolates over time and by region in Alaska Native persons. Susceptibility testing of H. pylori isolates to metronidazole, clarithromycin, amoxicillin, and tetracycline was performed using agar dilution. Susceptibility testing for levofloxacin was performed by Etest. Overall, 45% (532/1,181) of persons undergoing upper endoscopy were culture positive for H. pylori. Metronidazole resistance was demonstrated in isolates from 222/531 (42%) persons, clarithromycin resistance in 159/531 (30%) persons, amoxicillin resistance in 10/531 (2%) persons, and levofloxacin resistance in 30/155 (19%) persons; no tetracycline resistance was documented. The prevalence of metronidazole, clarithromycin, and levofloxacin resistance varied by region. Female patients were more likely than male patients to demonstrate metronidazole (P < 0.05) and clarithromycin (P < 0.05) resistance. No substantial change in the proportion of persons with resistant isolates was observed over time. Resistance to metronidazole, clarithromycin, and levofloxacin is more common among H. pylori isolates from Alaska Native persons than those from elsewhere in the United States.
Collapse
|
14
|
Abadi AT, Taghvaei T, Ghasemzadeh A, Mobarez AM. High frequency of A2143G mutation in clarithromycin-resistant Helicobacter pylori isolates recovered from dyspeptic patients in Iran. Saudi J Gastroenterol 2011; 17:396-9. [PMID: 22064338 PMCID: PMC3221114 DOI: 10.4103/1319-3767.87181] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/AIM Resistance to clarithromycin in H. pylori isolates is accepted as a main cause of treatment failure in developing countries. We aimed to determine the prevalence of clarithromycin-resistant strains isolated from dyspeptic patients in northern Iran, furthermore we aimed to assess the relationship between clinical outcomes of infection with point mutations. MATERIALS AND METHODS A total of 147 consecutive patients infected with H. pylori were included for determining the status of resistant H. pylori strains. With upper gastroscopy, three antral biopsies were taken from each patient, first section for rapid urea test, second for pathology and third section was used for bacterial culture in microbiologic lab. The antimicrobial susceptibility tests in this examination were agar dilution, in accordance with clinical and laboratory standards institue guidelines. Restriction fragment length polymorphism-PCR (RFLP-PCR) method was applied to determine the frequency of point mutations in 23s rRNA gene. Statistical analysis was performed using SPSS software (15.0) (SPSS, Inc., Chicago, Ill). Chi-square and Fisher's exact tests were applied to our analysis. A P value less than 5% was considered as statistically significant. RESULTS Our results showed that there was no point mutation in clarithromycin-susceptible strains of H. pylori. CONCLUSION The important findings in our study indicate that A2143G is the most prevalent point mutation (30/32: 93.7%) attributed in clarithromycin resistance among the H. pylori strains. The current study concluded that clarithromycin could still be involved in the empirical treatment of H. pylori infection, although a high frequency of A2143G mutation may increase the concerns regarding treatment failure.
Collapse
Affiliation(s)
- Amin T. Abadi
- Department of Bacteriology, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Tarang Taghvaei
- Department of Internal Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Ghasemzadeh
- Department of Biomedical Sciences, Marquette University, Milwaukee, WI, USA
| | - Ashraf M. Mobarez
- Department of Bacteriology, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran,Address for correspondence: Mrs. Ashraf Mohabati Mobarez, Department of Bacteriology, School of Medical Sciences, Tarbiat Modares University, P.O.Box: 14115-111, Tehran, Iran. E-mail:
| |
Collapse
|
15
|
Chang WL, Sheu BS, Cheng HC, Yang YJ, Yang HB, Wu JJ. Resistance to metronidazole, clarithromycin and levofloxacin of Helicobacter pylori before and after clarithromycin-based therapy in Taiwan. J Gastroenterol Hepatol 2009; 24:1230-5. [PMID: 19476562 DOI: 10.1111/j.1440-1746.2009.05829.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Clarithromycin-based triple therapy has been commonly applied as the first-line therapy for Helicobacter pylori eradication. Levofloxacin could serve as an alternative in either first-line or second-line regimens. This study surveyed the prevalence of levofloxacin resistance of H. pylori isolates in naive patients and in patients with a failed clarithromycin-based triple therapy. METHODS The study collected the H. pylori isolates from 180 naive patients and 47 patients with a failed clarithromycin-based triple therapy. Their in vitro antimicrobial resistance was determined by E-test. RESULTS The naive H. pylori isolates had resistance rates for amoxicillin, levofloxacin, clarithromycin and metronidazole of 0%, 9.4%, 10.6% and 26.7%, respectively. An evolutional increase of the primary levofloxacin resistance was observed in isolates collected after 2004, as compared to isolates collected before 2004 (16.3% vs 3.2%, P = 0.003). There was no evolutional increment of the primary clarithromycin resistance. The clarithromycin resistance elevated significantly after a failed clarithromycin-based triple therapy (78.7% vs 10.6%, P < 0.001). The post-treatment isolates remained to have a levofloxacin resistance rate of near 17%, but the levofloxacin-resistant isolates were correlated with a higher incidence of metronidazole resistance (P = 0.023). No strain was found to be resistant to amoxicillin even after eradication failure. CONCLUSION The levofloxacin resistance of naive H. pylori remains less than 10% in Taiwan. With relatively lower resistance to levofloxacin than to metronidazole of the H. pylori isolates collected after a failed clarithromycin-based therapy, proton pump inhibitor-levofloxacin-amoxicillin may be an alternative choice to serve as the second-line therapy.
Collapse
Affiliation(s)
- Wei-Lun Chang
- Department of Internal Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan
| | | | | | | | | | | |
Collapse
|
16
|
Sabbi T, De Angelis P, Dall'Oglio L. Helicobacter pylori infection in children: management and pharmacotherapy. Expert Opin Pharmacother 2008; 9:577-85. [PMID: 18312159 DOI: 10.1517/14656566.9.4.577] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Helicobacter pylori infection is mainly acquired during childhood: it is recognised as a cause of gastritis and peptic ulcer and it has been classified as a group A carcinogen by the World Health Organisation. The exact mode of transmission is as yet unknown. The aim of this review was to analyse the literature about H. pylori infection in paediatric patients. The large diffusion of H. pylori infection in paediatric patients, the absence of a specific clinical feature, the new non-invasive methods for diagnosis and follow-up, which are still not validated and the different therapeutic schedules have led to the necessity of determining the real clinical outcome in affected children and adolescents. The scope of the review was to identify better eradication therapy and the most important factors in treatment failure. The international literature has shown the importance of culture, antibiograms, the compliance of families and patients and the use of probiotics during triple eradication therapy. The review paid attention to the management, diagnostic techniques and therapy of this infection in paediatric patients.
Collapse
Affiliation(s)
- Tamara Sabbi
- Bambino Gesù Pediatric Hospital, Endoscopic Digestive Unit, Piazza S. Onofrio, 4-00165 Rome, Italy.
| | | | | |
Collapse
|
17
|
Abstract
Eradication therapy for Helicobacter pylori is recommended in a number of clinical conditions. In this article, we discuss the epidemiology and cellular mechanisms that result in antimicrobial resistance, the results of current eradication therapies, and new approaches to the management of Helicobacter pylori infection.
Collapse
Affiliation(s)
- Nimish Vakil
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
| | | |
Collapse
|
18
|
Kalach N, Serhal L, Asmar E, Campeotto F, Bergeret M, Dehecq E, Spyckerelle C, Charkaluk ML, Decoster A, Dupont C, Raymond J. Helicobacter pylori primary resistant strains over 11 years in French children. Diagn Microbiol Infect Dis 2007; 59:217-22. [PMID: 17662555 DOI: 10.1016/j.diagmicrobio.2007.05.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 04/28/2007] [Accepted: 05/06/2007] [Indexed: 01/06/2023]
Abstract
The yearly prevalence between 1994 and 2005 of primary resistance to amoxicillin, metronidazole, and clarithromycin of 377 Helicobacter pylori strains isolated from children was studied. All the H. pylori strains were susceptible to amoxicillin, 138/377 (36.7%) were resistant to metronidazole, 86/377 (22.8%) to clarithromycin, and 30/377 (7.9%) to both metronidazole and clarithromycin. Over the entire period, resistance to clarithromycin did not change, whereas metronidazole resistance decreased significantly from 43.3% (1994-1998) to 32% (1999-2005), P = 0.001.
Collapse
Affiliation(s)
- Nicolas Kalach
- Clinique de Pédiatrie Saint Antoine, Hôpital Saint Vincent de Paul, BD de Belfort, Université Catholique de Lille, 59020 Lille, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW This paper will review new developments in the etiology and management of gastric and duodenal diseases affecting children. RECENT FINDINGS Despite dropping prevalence rates in developed nations, most new Helicobacter pylori infections are primarily acquired during childhood. Resistance to standard triple therapy and falling eradication rates are increasing problems for clinicians, necessitating the study of alternative treatment strategies. Eosinophilic diseases of the gastrointestinal tract are being increasingly recognized. Although population-based epidemiology and the natural history of eosinophilic diseases are not yet fully characterized, biologic therapies are in development for the treatment of these chronic, often refractory, conditions. A recent US National Institutes of Health celiac disease consensus conference suggested that infants' diet constituents and timing of solid food introduction are potential environmental influences in the development of celiac disease. SUMMARY New methods of diagnosis and treatment are greatly impacting care of pediatric patients with gastric and duodenal diseases. Less invasive but highly accurate tools for diagnosis are becoming better validated. Early diagnosis and effective intervention in most gastroduodenal disorders of childhood can alter natural history and improve overall quality of life.
Collapse
Affiliation(s)
- Gayle Horvitz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | | |
Collapse
|
20
|
Abstract
This review summarizes the literature on Helicobacter pylori infection in childhood between April 2005 and March 2006, and includes guidelines of the Canadian Helicobacter Study Group Consensus Conference, noninvasive tests, optimum therapy regimens and problems with resistance, and reviews on immune mechanisms in the gastric mucosa that may lead to the development of an effective vaccine.
Collapse
Affiliation(s)
- Petronella Mourad-Baars
- Department of Pediatrics, Leiden University Medical Center, Leiden and Rijnland Hospital, Leiderdorp, the Netherlands.
| | | |
Collapse
|