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Yu HL, Su DS, Ma SZ, Qi XS. Approaches for detection of antibiotic resistance of Helicobacter pylori: Recent research advances. Shijie Huaren Xiaohua Zazhi 2023; 31:571-576. [DOI: 10.11569/wcjd.v31.i14.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection, a contagious disease, has affected approximately half of the global population. It is associated with the occurrence and development of many diseases, which seriously endangers human public health. Antibiotics play an important role in H. pylori eradication therapy, and the common regimens for H. pylori eradication contain one to three antibiotics. Antibiotic resistance is one of the main reasons for the failure of H. pylori eradication. Detection of antibiotic resistance can be helpful for individualized management, reduction of drug resistance, and improvement of H. pylori eradication. Methods to detect antibiotic resistance of H. pylori primarily consist of traditional drug sensitivity tests and molecular biology methods, such as polymerase chain reaction and its related techniques, DNA sequencing, fluorescence in situ hybridization, and gene chip. This paper reviews the recent advances in approaches for detection of antibiotic resistance of H. pylori.
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Affiliation(s)
- Hong-Lu Yu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Graduate School of Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Dong-Shuai Su
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- The 963rd Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Jiamusi 154000, Heilongjiang Province, China
| | - Shao-Ze Ma
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Xing-Shun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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2
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Sholeh M, Khoshnood S, Azimi T, Mohamadi J, Kaviar VH, Hashemian M, Karamollahi S, Sadeghifard N, Heidarizadeh H, Heidary M, Saki M. The prevalence of clarithromycin-resistant Helicobacter pylori isolates: a systematic review and meta-analysis. PeerJ 2023; 11:e15121. [PMID: 37016679 PMCID: PMC10066884 DOI: 10.7717/peerj.15121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/03/2023] [Indexed: 04/06/2023] Open
Abstract
Background Knowledge of global clarithromycin (CLA)-resistant rates of Helicobacter pylori (H. pylori) is crucial for decision of the most appropriate eradication therapies with good clinical outcomes. Therefore, this review and meta-analysis aimed to evaluate the global prevalence of the CLA resistance in H. pylori to provide some guidance for selecting the first-line antibiotics. Method A comprehensive search was performed for relevant literature until April 2021 in PubMed, Embase, and Web of Science databases. Freeman-Tukey double arcsine transformation was performed to estimate the weighted pooled prevalence of resistance. Results The meta-analysis included 248 articles. The prevalence of CLA-resistant H. pylori was 27.53% (95% CI [25.41-29.69]). The heterogeneity between reports was significant (I2 = 97.80%, P < 0.01). The resistance rate increased from 24.28% in 2010-2017 to 32.14% in 2018-2021 (P < 0.01). Iran, with 38 articles, has the most report. Nevertheless, Switzerland, Portugal, and Israel had the highest resistance rates (67.16%, 48.11%, and 46.12%, respectively). The heterogeneity between the continents and the antimicrobial susceptibility methods also interpreted standard guidelines and breakpoints was insignificant (P > 0.05). Conclusion Overall CLA resistance rate was 27.53%, worldwide. The difference in CLA resistance rate among the included studies can be due to several reasons such as differences in antibiotic prescription rates in various geographic areas, use of different breakpoints or inaccurate criteria in performed studies, and the emergence of multidrug-resistant (MDR) strains.
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Affiliation(s)
- Mohammad Sholeh
- Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran
| | - Saeed Khoshnood
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Taher Azimi
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jasem Mohamadi
- Department of Pediatrics, School of Medicine, Emam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Vahab Hassan Kaviar
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Marzieh Hashemian
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Somayeh Karamollahi
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Nourkhoda Sadeghifard
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Hedayat Heidarizadeh
- Department of Pediatrics, School of Medicine, Emam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohsen Heidary
- Department of Laboratory Sciences, School of Paramedical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Morteza Saki
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Lormohammadi L, Nikkhahi F, Bolori S, Karami AA, Hajian S, Rad N, Peymani A, Samimi R. High level of resistance to metronidazole and clarithromycin among Helicobacter pylori clinical isolates in Qazvin province, Iran. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2022.101494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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4
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Isolation of dupA-positive and clarithromycin-resistant Helicobacter pylori from Iranian patients with duodenal ulcer. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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5
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Anis S, Farooqi SR, Niaz SK. Characterization of Domain V Mutations in Clinical Isolates of Helicobacter pylori in Pakistan and Their Effect on Clarithromycin MIC. Infect Drug Resist 2021; 14:3393-3403. [PMID: 34466005 PMCID: PMC8402994 DOI: 10.2147/idr.s306878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/06/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Clarithromycin is commonly prescribed for H. pylori infection. Domain V mutations are responsible for clarithromycin resistance. This study was aimed to characterize the clarithromycin resistance and its associated mutations in clinical isolates of H. pylori in Pakistan. MATERIALS AND METHODS Infection was diagnosed in 93 patients' biopsies using culture, rapid urease test, 16S rRNA, and vacA gene multiplex PCR. Clarithromycin resistance was assessed by the agar dilution method. Mutations were detected by PCR-RFLP using 46 (1.4 kb) domain V fragments. Sequencing was executed for 13 domain V fragments, of which 12 showed unusual amplicon size (1.2 kb) and 01 had a new MboII RFLP pattern. RESULTS A total of 48 (83%) strains were obtained from 58 (62.3%) PCR H. pylori-positive samples. Resistance (MIC ≥ 0.001 mg/mL) and intermediate resistance phenotype (MIC = 0.0005 mg/mL) was observed in 22 (46%), and 10 (21%) isolates, respectively. The primary resistance was found in 23 (39.6%) samples. PCR-RFLP detected A2142G, A2143G, and double mutations in 19, 04, and 01 resistant strain, respectively. Sequencing of 10 amplicons obtained from intermediated resistant strains and 03 amplicons from resistant strains showed 138 new mutations. Among them, T2182C was also seen in 04 intermediated resistant isolates, whereas A2142G, A2143G, and A2143C were observed in resistant isolates. The new MboII RFLP pattern in an intermediated resistant strains was due to A1761G mutation. CONCLUSION H. pylori domain V mutations showed extensive diversity. Multiple mutations in domain V may give endurance to H. pylori against clarithromycin. Further investigations on the molecular mechanism of antibiotic resistance in H. pylori seem crucial at this stage.
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Affiliation(s)
- Shumaiza Anis
- Department of Genetics, University of Karachi, Karachi, Sindh, Pakistan
| | - Shakeel R Farooqi
- Department of Genetics, University of Karachi, Karachi, Sindh, Pakistan
| | - Saad K Niaz
- Surgical Unit IV, Civil Hospital, Karachi, Sindh, Pakistan
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Sholeh M, Maleki F, Krutova M, Bavari S, Golmoradi R, Sadeghifard N, Amiriani T, Kouhsari E. The increasing antimicrobial resistance of Helicobacter pylori in Iran: A systematic review and meta-analysis. Helicobacter 2020; 25:e12730. [PMID: 32705749 DOI: 10.1111/hel.12730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Antimicrobial resistance of Helicobacter pylori can result in eradication failure. Metadata on the antimicrobial resistance of H pylori in Iran could help to formulate H pylori eradication strategies in Iran. METHODS A systematic review was performed after searching in MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Library. A meta-analysis was performed, and a comparison of the rates between children and adults; time periods (1999-2010, 2011-2016, 2017-2019); and the methods used was carried out. RESULTS A total of 66 studies investigating 5936 H pylori isolates were analyzed. The weighted pooled resistance (WPR) rates were as follows: clarithromycin 21% (95% CI 16-26), metronidazole 62% (95% 57-67), clarithromycin in combination with metronidazole 16% (95% CI 10-23), ciprofloxacin 24% (95% CI 15-33), levofloxacin 18% (95% CI 9-30), erythromycin 29% (95% CI 12-50), furazolidone 13% (95% CI 4-27), tetracycline 8% (95% CI 5-13), and amoxicillin 15% (95% CI 9-22). During the three time periods, there was an increased resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline (P ˂ .05). Furazolidone and a clarithromycin/metronidazole combination had the higher resistance rates in children (P ˂ .05). CONCLUSION An increasing rate of resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline in Iranian H pylori isolates was identified. In children, the resistance to furazolidone and a combination of clarithromycin and metronidazole is higher compared to adults. As a stable, high resistance to metronidazole was found in children and adults in all Iranian provinces, we suggest that metronidazole should not be included in the Iranian H pylori eradication scheme.
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Affiliation(s)
- Mohammad Sholeh
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farajolah Maleki
- Department of Laboratory Sciences, School of Allied Medical Sciences, Ilam University of Medical sciences, Ilam, Iran
| | - Marcela Krutova
- Department of Medical Microbiology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Shirin Bavari
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Rezvan Golmoradi
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nourkhoda Sadeghifard
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Taghi Amiriani
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ebrahim Kouhsari
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran.,Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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7
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Chakari-Khiavi A, Hasannejad-Bibalan M, Shahriari F, Chakari-Khiavi F, Mojtahedi A, Sedigh Ebrahim-Saraie H. Risk of Helicobacter pylori infection and childhood asthma in Iran: A systematic review and meta-analysis. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Alihosseini S, Ghotaslou R, Heravi FS, Ahmadian Z, Leylabadlo HE. Management of antibiotic-resistant Helicobacter pylori infection: current perspective in Iran. J Chemother 2020; 32:273-285. [PMID: 32657237 DOI: 10.1080/1120009x.2020.1790889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Helicobacter pylori is a common gastric bacterial pathogen implicated in the pathogenesis of many digestive tract disorders. H. pylori infection prevalence has been reported alarmingly in Iran. A plethora of studies have been conducted to evaluate the efficiency of first-line and second-line eradication attempts in patients diagnosed with H. pylori infections in Iran. The present study, was evaluated the efficacy of first-line and second-line therapy in H. pylori infections in Iran. We aimed to consider the literature review of the various library and electronic databases (Science Direct, PubMed, and Google Scholar) until 2020. The frequency of bacterial resistance to tetracycline, ampicillin, trimethoprim, erythromycin, ofloxacin, and metronidazolewas found to be high in Iran, while the most effective antibiotics were clarithromycin, rifampin, rifampicin, tetracycline, amoxicillin, ciprofloxacin, levofloxacin, moxifloxacin, and azithromycin. The therapeutic choice for H. pylori eradication in Iran could be quadruple therapy using two antibiotics amoxicillin and metronidazole/clarithromycin for the first-line regimen, and a combination of furazolidone plus tetracycline/amoxicillin and bismuth plus proton pump inhibitor for the second-line regimen. Due to increased antibiotic resistance in our region, empirical therapy must be replaced by more targeted treatment based on antimicrobial drug resistance profiles obtained from patients. Although we limited our investigation on the H. pylori eradication regimens in Iran, the results can be generalized to any region as long as the patterns of resistance are the same.
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Affiliation(s)
- Samin Alihosseini
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ghotaslou
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Zainab Ahmadian
- Department of Pharmaceutics, School of Pharmacy, Zanjan University of Medical Science, Zanjan, Iran
| | - Hamed Ebrahimzadeh Leylabadlo
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Khademi F, Sahebkar A. An Updated Systematic Review and Meta-Analysis on the Helicobacter pylori Antibiotic Resistance in Iran (2010-2020). Microb Drug Resist 2020; 26:1186-1194. [PMID: 32354289 DOI: 10.1089/mdr.2020.0088] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This updated systematic review and meta-analysis followed two objectives: (1) to determine Helicobacter pylori antibiotic resistance in Iran during 2010-2020 and (2) to assess the trend of resistance from 1997 to 2020. A systematic search in multiple databases, including ISI Web of Knowledge, PubMed, Scopus, Google Scholar, and the Scientific Information Database (SID), was performed using MeSH-extracted keywords. Meta-analysis was done on extracted data from a total of 27 included citations published between 2010 and January 20, 2020. The overall mean prevalence of H. pylori resistance was 64.9% for metronidazole, 25.3% for clarithromycin, 20.7% for amoxicillin, 16.1% for tetracycline, 21.9% for levofloxacin, 22.8% for rifampicin, 27.2% for furazolidone, 32.3% for ciprofloxacin, and 38.7% for erythromycin. In addition, the prevalence of multidrug-resistant strains of H. pylori was 26.5% in Iran. The pooled prevalence of point mutations A2143G, A2142G, and A2142C associated with clarithromycin resistance were 46.6%, 37.2%, and 5.5%, respectively; mutations in frxA and rdxA genes associated with metronidazole resistance were 46.4% and 19.7%, respectively; gyrA and gyrB genes mutations among fluoroquinolone-resistant strains were 55.3% and 48.2%, respectively; and resistance associated with integrons was 47%. According to the present findings, resistance of H. pylori to antibiotics used for eradication therapy has reached an alarming level in Iran. Furthermore, the trend of H. pylori resistance has increased between 1997 and 2020. Hence, continuous surveillance on resistance patterns, logical prescription and appropriate consumption of antibiotics, and selecting effective therapeutic regimens in accordance with local resistance patterns are required to prevent further spread of resistance and ensuing treatment failures.
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Affiliation(s)
- Farzad Khademi
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Amirhossein Sahebkar
- Halal Research Center of IRI, FDA, Tehran, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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10
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Chu A, Wang D, Guo Q, Lv Z, Yuan Y, Gong Y. Molecular detection of
H. pylori
antibiotic‐resistant genes and molecular docking analysis. FASEB J 2019; 34:610-618. [PMID: 31914672 DOI: 10.1096/fj.201900774r] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Aining Chu
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
| | - Dan Wang
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
| | - Qianqian Guo
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
| | - Zhi Lv
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
| | - Yuan Yuan
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
| | - Yuehua Gong
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
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High Prevalence of Antibiotic Resistance in Iranian Helicobacter pylori Isolates: Importance of Functional and Mutational Analysis of Resistance Genes and Virulence Genotyping. J Clin Med 2019; 8:jcm8112004. [PMID: 31744181 PMCID: PMC6912791 DOI: 10.3390/jcm8112004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 12/14/2022] Open
Abstract
The high prevalence of antibiotic resistance in Helicobacter pylori has become a great challenge in Iran. The genetic mutations that contribute to the resistance have yet to be precisely identified. This study aimed to investigate the prevalence of antibiotic resistance and virulence markers in Iranian H. pylori isolates and to analyze if there is any association between resistance and genotype. Antibiotic susceptibility patterns of 68 H. pylori isolates were investigated against metronidazole, clarithromycin, amoxicillin, rifampicin, ciprofloxacin, levofloxacin, and tetracycline by the agar dilution method. The frxA, rdxA, gyrA, gyrB, and 23S rRNA genes of the isolates were sequenced. The virulence genotypes were also determined using PCR. Metronidazole resistance was present in 82.4% of the isolates, followed by clarithromycin (33.8%), ciprofloxacin (33.8%), rifampicin (32.4%), amoxicillin (30.9%), levofloxacin (27.9%), and tetracycline (4.4%). Overall, 75% of the isolates were resistant to at least two antibiotics tested and considered as a multidrug resistance (MDR) phenotype. Most of the metronidazole-resistant isolates carried frameshift mutations in both frxA and rdxA genes, and premature termination occurred in positions Q5Stop and Q50Stop, respectively. Amino acid substitutions M191I, G208E, and V199A were predominantly found in gyrA gene of fluoroquinolone-resistant isolates. A2143G and C2195T mutations of 23S rRNA were found in four clarithromycin-resistant isolates. Interestingly, significant associations were found between resistance to metronidazole (MNZ) and cagA-, sabA-, and dupA-positive genotypes, with p = 0.0002, p = 0.0001, and p = 0.0001, respectively. Furthermore, a significant association was found between oipA “on” status and resistance to amoxicillin (AMX) (p = 0.02). The prevalence of H. pylori antibiotic resistance is high in our region, particularly that of metronidazole, clarithromycin, ciprofloxacin, and MDR. Simultaneous screening of virulence and resistance genotypes can help clinicians to choose the appropriate therapeutic regime against H. pylori infection.
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12
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Khani S, Talebi Bezmin Abadi A, Mohabati Mobarez A. Clarithromycin-Susceptible But Virulent Helicobacter pylori Strains Infecting Iranian Patients' Stomachs. Infect Drug Resist 2019; 12:3415-3420. [PMID: 31802920 PMCID: PMC6830365 DOI: 10.2147/idr.s223602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction Helicobacter pylori was discovered first in the stomachs of patients with gastritis and ulcers by Marshall and Warren in 1982. This discovery majorly affected many research areas of gastroenterology. Since then, the main aim has been to eradicate this microaerophilic bacterium from the stomachs of infected subjects. Methods We studied symptomatic cases by endoscopic surgery and examined the prevalence of cagA-vacA genotypes among the H. pylori isolates. H. pylori isolated from antral biopsies of patients with gastritis and duodenal ulcer were subjected to antimicrobial susceptibility testing and PCR genotyping by using routine bacterial cultures. Clarithromycin-susceptibility profiling was done by the E-test. DNA was extracted using standard manufacturer protocols with minor modifications and cagA and vacA genotyping was done PCR. Results In our study, all strains identified as H. pylori in culture (61/81) were confirmed by PCR by amplifying a fragment of the glmM gene. Totally, 61 patients were confirmed to be positive for H. pylori and they were included in the genotyping and antibiotic-susceptibility testing. Thirteen H. pylori strains were determined to be resistant to clarithromycin. Discussion Current accumulating data indicate that both clarithromycin-resistant and susceptible isolates of H. pylori need to be screened and tracked in populations.
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Affiliation(s)
- Shadiyeh Khani
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Amin Talebi Bezmin Abadi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ashraf Mohabati Mobarez
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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13
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Asl SF, Pourvahedi M, Mojtahedi A, Shenagari M. Analysis of babA, cagE and cagA Genes in Helicobacter pylori from Upper Gastric Patients in the North of Iran. Infect Disord Drug Targets 2019; 19:274-278. [PMID: 29766826 DOI: 10.2174/1871526518666180515113218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/20/2018] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Helicobacter pylori is a Gram-negative bacterium which has a serious effect on up to half of the world's population and has been related to different gastric diseases. The goal of this study was to assess the frequency of babA, cagE and cagA genotypes among H. pylori strains isolated from gastric biopsies of endoscopic patients in the north of Iran. METHODS The present study was performed on 90 strains of H. pylori isolated from patients with gastric diseases (Gastric ulcer (GU), Duodenal ulcer (DU), Gastritis (G), Non-ulcer dyspepsia (NUD) and Gastric adenocarcinoma (GC)). DNA was extracted from all isolated strains and PCR method was performed to detect the prevalence of babA2, cagE and cagA genes using specific primers. RESULTS Among 90 samples of H. pylori, babA2, cagE, and cagA genes were detected in 42.2%, 30% and 82.2% of strains respectively. The statistical analysis showed that the prevalence of cagA gene in GU, G, DU, and NUD was significantly higher than other genes. Moreover, cagA, and babA2 genes were significantly more prevalent in GC patients compared to cagE gene. Our isolates exhibited 8 distinct arrangements of virulence patterns. The occurrence of cagA (35.6%) was the most prevalent pattern followed by cagA/babA2 (20%) and cagA/babA2/cagE (14.4%). CONCLUSION In summary, as first report from Guilan province in the north of Iran, we showed significant association between the presence of babA2, cagE, and cagA genes in different types of gastric disorders.
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Affiliation(s)
- Saba Fakhrieh Asl
- Internal Medicine Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrnaz Pourvahedi
- Genetics Department, Faculty of Basic Sciences, Guilan University, Rasht, Iran
| | - Ali Mojtahedi
- Cellular and Molecular Research Center, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Microbiology Department, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Shenagari
- Microbiology Department, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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14
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Mojtahedi A, Fakhrieh Asl S, Aminian K, Pourvahedi M, Saadat F, Fallah Karkan M. The association between iceA and vacA allelic gene variations of Helicobacter pylori strains and gastric disorders. GENE REPORTS 2018. [DOI: 10.1016/j.genrep.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions. Gastroenterology 2018; 155:1372-1382.e17. [PMID: 29990487 PMCID: PMC6905086 DOI: 10.1053/j.gastro.2018.07.007] [Citation(s) in RCA: 702] [Impact Index Per Article: 117.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS In 2017, the World Health Organization (WHO) designated clarithromycin-resistant Helicobacter pylori a high priority for antibiotic research and development. However, there are no clear data on the global distribution of resistance or its clinical effects. We performed a systematic review and meta-analysis to assess the distribution of H pylori resistance to commonly used antibiotics and to measure the association between antibiotic resistance and treatment failure. METHODS We searched publication databases for studies that assessed rates of H pylori resistance to clarithromycin, metronidazole, levofloxacin, amoxicillin, or tetracycline. Pooled estimates of primary and secondary resistance and 95% confidence intervals (CIs) were grouped by WHO region. The association between antibiotic resistance and treatment failure was measured by extracting data on treatment efficacy in patients with resistant and susceptible isolates and pooling odds ratios with 95% CIs. RESULTS We identified 178 studies, comprising 66,142 isolates from 65 countries. Primary and secondary resistance rates to clarithromycin, metronidazole, and levofloxacin were ≥15% in all WHO regions, except primary clarithromycin resistance in the Americas (10%; 95% CI, 4%-16%) and South-East Asia region (10%; 95% CI, 5%-16%) and primary levofloxacin resistance in the European region (11%; 95% CI, 9%-13%). There was considerable heterogeneity (I2 > 75%) among all analyses-this might have resulted from the grouping of resistance rates by country. Increasing antibiotic resistance was observed in most WHO regions. Resistance to clarithromycin was significantly associated with failure of clarithromycin-containing regimens (odds ratio, 6.97; 95% CI, 5.23-9.28; P < .001). CONCLUSIONS Resistance of H pylori to antibiotics has reached alarming levels worldwide, which has a great effect on efficacy of treatment. Local surveillance networks are required to select appropriate eradication regimens for each region.
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Affiliation(s)
- Alessia Savoldi
- Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen, Germany
| | - Elena Carrara
- Division of Infectious Diseases, Department of Diagnostic and Public Health, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - David Y Graham
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Michela Conti
- Division of Infectious Diseases, Department of Diagnostic and Public Health, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen, Germany; Division of Infectious Diseases, Department of Diagnostic and Public Health, G.B. Rossi University Hospital, University of Verona, Verona, Italy.
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Hajiani E, Alavinejad P, Avandi N, Masjedizadeh AR, Shayesteh AA. Comparison of Levofloxacin-Based, 10-day Sequential Therapy with 14-day Quadruple Therapy for Helicobacter Pylori Eradication: A Randomized Clinical Trial. Middle East J Dig Dis 2018; 10:242-248. [PMID: 31049172 PMCID: PMC6488509 DOI: 10.15171/mejdd.2018.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/02/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND
Considering the importance of Helicobacter pylori (H. pylori) eradication, this clinical trial
was designed to prospectively evaluate the efficacy of levofloxacin-based, sequential therapy in
comparison with quadruple therapy for eradicating H. pylori.
METHODS
Overall 156 patients with dyspepsia and H. pylori infection were included in this study and
were randomly allocated to either 10-day sequential therapy group (group A) to receive pantoprazole
(40 mg twice daily), amoxicillin (1 gr twice daily), levofloxacin (500 mg twice daily), and
tinidazole (500 mg twice daily) (PALT) or 14-day quadruple therapy group (group B) to receive
pantoprazole, clarithromycin, bismuth subcitrate, and amoxicillin (PABC). At the end of the study
the eradication rate in each group was assessed by urea breath test (UBT).
RESULTS
Age range of the participants was 18-65 years (average 36.9 years) and 50% of them (78
patients) were men. 78 patients were allocated to group A and 78 patients to groupe B. After antibiotic
therapy, all the patients received acid suppression therapy with Proton Pump Inhibitor (PPI)
for 4 weeks and then the eradication rate was confirmed by UBT (Heli FAN plus 13C, Germany).
Before performing UBT, all the participants were requested to halt consumption of PPI for at least
1 week. During the treatment there was not any major complication but in group A (sequential
therapy), two patients complained of minor complications including musculoskeletal pain. None
of the patients in group B had any complaint or side effect.
The rate of H. pylori eradication in group A was 78.2% (61 patients) while this rate in group B was
83.3% (65 patients) with no significant difference between the two groups (p = 0.42). In subgroup
analysis, the rate of eradication among men in group A and B were 76.9% and 89.7%, respectively
(p = 0.22) while the eradication rate among women were 79.4% and 76.9%, respectively (p = 1.00).
CONCLUSION
It seems that levofloxacin base sequential therapy does not have any advantage in comparison
with quadruple regimen and until finding any more effective short course therapy for H. Pylori
eradication; we encourage quadruple regimen to be used as the first line therapy.
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Affiliation(s)
- Eskandar Hajiani
- Alimentary Tract Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Pezhman Alavinejad
- Alimentary Tract Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nahid Avandi
- Medical Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Ali Akbar Shayesteh
- Alimentary Tract Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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17
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Wang YH, Li Z, Wang L, Zhu-Ge LY, Zhao RL, Wu S, Wang Y, An Y, Xie Y. A systematic review and meta-analysis of genotypic methods for detecting antibiotic resistance in Helicobacter pylori. Helicobacter 2018; 23:e12467. [PMID: 29405526 DOI: 10.1111/hel.12467] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Antibiotic susceptibility testing is essential for tailored treatments to cure Helicobacter pylori (H. pylori) infection. However, phenotypic methods have some limitations. OBJECTIVES To evaluate the feasibility of genotypic detection methods compared with phenotypic detection methods using samples taken from H. pylori-infected patients. METHODS Literature searches were conducted in the following databases (from January 2000 to November 2016): PubMed, Embase, the Cochrane Library, and Web of Science. A meta-analysis and systematic review was performed for studies that compared genotypic methods with phenotypic methods for the detection of H. pylori antibiotic susceptibility. RESULTS This meta-analysis showed that the pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for the A2142G/C and/or A2143G combination for the detection of clarithromycin resistance in the strain samples were 0.97 (95% CI: 0.94-0.99), 1.00 (95% CI: 0.99-1.00), and 13 742 (95% CI: 1708-110 554), respectively. The pooled sensitivity, specificity, and DOR for the A2142G/C and/or A2143G combination for the detection of clarithromycin resistance in biopsy samples were 0.96 (95% CI: 0.90-0.99), 0.96 (95% CI: 0.91-0.99), and 722 (95% CI: 117-4443), respectively. The summarized sensitivity, specificity, and DOR value for the ability of the genotypic methods to detect quinolone resistance in biopsy specimens were 0.97 (95% CI: 0.87-0.99), 0.99 (95% CI: 0.92-1.00), and 6042 (95% CI: 486-75 143), respectively. CONCLUSION The genotypic detection methods were reliable for the diagnosis of clarithromycin and quinolone resistance in the strain and biopsy specimens. The A2142G/C and/or A2143G combination had the best sensitivity and specificity for the detection of clarithromycin resistance.
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Affiliation(s)
- You-Hua Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Zhen Li
- Department of Medical College, Nanchang University, Nanchang, Jiangxi Province, China
| | - Le Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.,Jiangxi Provincial Key Laboratory of Translational Medicine and Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi Province, China
| | - Li-Ya Zhu-Ge
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Ru-Lin Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.,Department of Medical College, Nanchang University, Nanchang, Jiangxi Province, China
| | - Shuang Wu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Ya Wang
- Department of Medical College, Nanchang University, Nanchang, Jiangxi Province, China
| | - Ying An
- Department of Medical College, Nanchang University, Nanchang, Jiangxi Province, China
| | - Yong Xie
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
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Abstract
PURPOSE OF REVIEW Treatment of Helicobacter pylori is difficult nowadays because of its high resistance. The prevalence and mechanism of resistance, the different methods to detect it and the clinical implication of resistance were addressed in several research papers last year. RECENT FINDINGS Clarithromycin-resistant H. pylori has been recognized by the WHO as 'high priority', for which new antibiotics are needed. Moreover, the Maastricht consensus recommended, in areas with high resistance, that susceptibility tests should be performed, at least after a treatment failure. SUMMARY Metronidazole and clarithromycin resistance rates are alarming although they vary among populations. Tetracycline and amoxicillin-resistance are very low in most countries. H. pylori resistance can be detected by phenotypic or by molecular methods. Different break points may be used when performing an antimicrobial susceptibility test, so comparing resistance among different populations is challenging. Genomic techniques open new possibilities in the diagnosis of H. pylori, and the detection of H. pylori and its antimicrobial resistance in faeces is an interesting approach. Eradication rates are dependent on the susceptibility of the strain to metronidazole and clarithromycin, being lower in patients infected with a resistant strain.
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Gong Y, Yuan Y. Resistance mechanisms of Helicobacter pylori and its dual target precise therapy. Crit Rev Microbiol 2018; 44:371-392. [PMID: 29293032 DOI: 10.1080/1040841x.2017.1418285] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Helicobacter pylori drug resistance presents a significant challenge to the successful eradication of this pathogen. To find strategies to improve the eradication efficacy of H. pylori, it is necessary to clarify the resistance mechanisms involved. The mechanisms of H. pylori drug resistance can be investigated from two angles: the pathogen and the host. A comprehensive understanding of the molecular mechanisms of H. pylori resistance based on both pathogen and host would aid the implementation of precise therapy, or ideally "dual target precise therapy" (bacteria and host-specific target therapy). In recent years, with increased understanding of the mechanisms of H. pylori resistance, the focus of eradication has shifted from disease-specific to patient-specific treatment. The implementation of "precision medicine" has also provided a new perspective on the treatment of infectious diseases. In this article, we systematically review current research on H. pylori drug resistance from the perspective of both the pathogen and the host. We also review therapeutic strategies targeted to pathogen and host factors that are aimed at achieving precise treatment of H. pylori.
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Affiliation(s)
- Yuehua Gong
- a Tumor Etiology and Screening Department of Cancer Institute and General Surgery , the First Hospital of China Medical University , Shenyang , China.,b Key Laboratory of Cancer Etiology and Prevention (China Medical University) Liaoning Provincial Education Department , Shenyang , China.,c National Clinical Research Center for Digestive Diseases , Xi'an , China
| | - Yuan Yuan
- a Tumor Etiology and Screening Department of Cancer Institute and General Surgery , the First Hospital of China Medical University , Shenyang , China.,b Key Laboratory of Cancer Etiology and Prevention (China Medical University) Liaoning Provincial Education Department , Shenyang , China.,c National Clinical Research Center for Digestive Diseases , Xi'an , China
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Fakheri H, Saberi Firoozi M, Bari Z. Eradication of Helicobacter Pylori in Iran: A Review. Middle East J Dig Dis 2017; 10:5-17. [PMID: 29682242 PMCID: PMC5903928 DOI: 10.15171/mejdd.2017.84] [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] [Received: 09/05/2017] [Accepted: 12/02/2017] [Indexed: 12/11/2022] Open
Abstract
Helicobacter pylori (H. pylori) infection is one of the most common bacterial infections,
affecting almost half of the world’s population. It is associated with peptic ulcer disease,
gastric adenocarcinoma, and lymphoma. In Iran, the prevalence of H. pylori infection
has been reported to be between 36% and 90% in different geographic regions.
Several studies have assessed the efficacy of different therapeutic options for firstline
and second-line H. pylori eradication in Iran; however, the results are conflicting.
Therefore, we conducted a review to evaluate different studies in order to select the best
options and to provide recommendations for H. pylori eradication in Iran. Accordingly,
we searched through PubMed to obtain relevant randomized clinical trials published in
English language up to June 2017.
According to our study, among first-line eradication regimens, bismuth-based furazolidone-
or clarithromycin-containing quadruple therapies, hybrid regimen, and concomitant
therapy seem to be appropriate options. Also, 10- or 14-day clarithromycin-containing
triple therapy can be used if local H. pylori resistance to clarithromycin is known to be
less than 15%.
For second-line H. pylori eradication, bismuth-based quadruple therapies and 14-day
levofloxacin-based triple therapy can be used, provided that antibiotics other than those
used in the first-line regimen are used. Third-line H. pylori eradication regimens have
not been addressed in Iranian studies. However, most guidelines recommend treatment
according to the results of culture and susceptibility testing.
Although we limited our investigation to H. pylori eradication regimens in Iran, the
results are transferrable to any region as long as the patterns of antibiotic resistance are
the same.
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Affiliation(s)
- Hafez Fakheri
- Professor of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Saberi Firoozi
- Professor of Gastroenterology, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Bari
- Assistant professor of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Khademi F, Sahebkar AH, Vaez H, Arzanlou M, Peeridogaheh H. Characterization of clarithromycin-resistant Helicobacter pylori strains in Iran: A systematic review and meta-analysis. J Glob Antimicrob Resist 2017; 10:171-178. [DOI: 10.1016/j.jgar.2017.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/01/2017] [Accepted: 05/25/2017] [Indexed: 12/19/2022] Open
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22
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Sohrabi M, Khashei R, Alizadeh M, Asl MKH, Nejati MA, Dara M, Bazargani A. Low Rate of babA2 Genotype among Iranian Helicobacter pylori Clinical Isolates. J Clin Diagn Res 2017; 11:DC32-DC36. [PMID: 28892894 DOI: 10.7860/jcdr/2017/24810.10277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/04/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The Blood Group Antigen-Binding Adhesion (babA), Outer Inflammatory Protein (oipA) and Sialic Acid-Binding Adhesin (sabA) as outer membrane proteins involved in Helicobacter pylori adherence to gastric mucosa have been suggested to have a role in the pathogenesis. AIM To investigate the frequency of H. pylori isolates babA2, oipA and sabA genes in Iranian dyspeptic patients. MATERIALS AND METHODS DNAs were extracted from H. pylori -positive cultures taken from 100 different dyspeptic patients. Genotyping was performed by Polymerase Chain Reaction (PCR), using the specific primers for babA2, oipA and sabA genes. Chi square test was used to investigate association between variables, p<0.05 was considered statistically significant. RESULTS All (100%) isolates possessed oipA and sabA genotypes, whereas babA2 was detected in 22% of isolates. There was no significant relationship between presence of genes with clinical outcome. The combined genotype oipA +/sabA +/ babA2- was correlated with gastritis. The rate of babA2 genotype in our isolates was lower than other Iranian reports. CONCLUSION Frequency of babA2 genotype among H. pylori isolates from Southwest of Iran is considerably less than other regions of Iran. Due to heterogeneity of H. pylori strains in different geographic regions, further work will be needed to understand the role of these virulence genes in H. pylori pathogenesis and their possible association with disease outcome.
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Affiliation(s)
- Maryam Sohrabi
- Student, Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Khashei
- Assistant Professor, Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahvash Alizadeh
- Assistant Professor, Department of Internal Medicine, Gastroenterology Ward, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad-Kazem Hosseini Asl
- Associate Professor, Department of Internal Medicine, Gastroenterology Ward, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad-Ali Nejati
- Assistant Professor, Department of Internal Medicine, Gastroenterology Ward, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahintaj Dara
- Ph.D Student, Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdollah Bazargani
- Associate Professor, Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Wang D, Gong YH, Yuan Y. Bacterial factors associated with Helicobacter pylori antibiotic resistance. Shijie Huaren Xiaohua Zazhi 2016; 24:4102-4109. [DOI: 10.11569/wcjd.v24.i29.4102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is the most widespread chronic bacterial infection and is closely associated with many diseases. In recent years, however, H. pylori is becoming increasingly difficult to eradicate due to the growing antibiotic resistance. Among the reasons for the failed eradication, some factors of H. pylori itself play a main role. H. pylori can resist antibiotics by producing inactivating enzymes, changing the drug targets, preventing oxidation-reduction electron transfer, decreasing membrane permeability and activating efflux pump, changing bacterial metabolic state and so on. Elucidating the mechanism of antibiotic resistance will be helpful in developing new targeted drugs to effectively eradicate H. pylori. Here, we review the bacteria factors associated with H. pylori antibiotic resistance.
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