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Zhou Y, Zhang Y, Du S. Antibiotic resistance in Helicobacter pylori among children and adolescents in East Asia: A systematic review and meta-analysis. Chin Med J (Engl) 2024; 137:1926-1938. [PMID: 38230488 PMCID: PMC11332731 DOI: 10.1097/cm9.0000000000002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND In East Asia, Helicobacter pylori ( H. pylori ) infection and related diseases are common, primarily during childhood and adolescence. The rates of primary antibiotic resistance in H. pylori among East Asian children and adolescents have not been extensively explored; few relevant systematic reviews or meta-analyses have been conducted. We evaluated the rates of antibiotic resistance in H. pylori among East Asian children and adolescents, with the goal of facilitating individualized treatment recommendations. METHODS We searched PubMed, Embase, and the Cochrane Library for studies in any language published up to February 2023 that explored antibiotic resistance in H. pylori among East Asian children and adolescents. We used MeSH and non-MeSH terms related to the topic, including terms related to children, adolescents, antibiotic resistance, H. pylori , and nations or regions. Additionally, we reviewed the reference lists of relevant articles. Studies that matched our strict predefined eligibility criteria were included in the screening process. Using established assessment methods, we evaluated the quality of the included studies. RESULTS We identified 15 observational studies involving 4831 H. pylori isolates, all published between 2001 and 2022. There was substantial primary antibiotic resistance in H. pylori isolates from East Asian children and adolescents. The rates of primary resistance were 51% (95% confidence interval [CI]: 40-62%) for metronidazole; 37% (95% CI: 20-53%) for clarithromycin; 19% (95% CI: 11-28%) for levofloxacin; and less than 3% each for amoxicillin, tetracycline, and furazolidone. Subgroup analysis revealed a prominent increase in metronidazole resistance over time. Clarithromycin and levofloxacin resistance rates fluctuated between 2005 and 2015, then remained stable; other antibiotic resistance rates were generally stable. Metronidazole, clarithromycin, and levofloxacin resistance rates were significantly higher in the Chinese mainland than in other East Asian regions. The rates of dual and multiple antibiotic resistance were 28% (95% CI: 21-36%) and 10% (95% CI: 7-14%), highlighting the potential for diverse resistance patterns. CONCLUSIONS H. pylori isolates from East Asian children and adolescents exhibit high levels of metronidazole and clarithromycin resistance, particularly in the Chinese mainland. The non-negligible rates of dual and multiple resistance highlight the complexity of this problem. REGISTRATION PROSPERO, No. CRD42023402510.
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Affiliation(s)
- Yuhang Zhou
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yanli Zhang
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Shiyu Du
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
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Zhou D, Wang W, Gu L, Han M, Hao W, Huang J, Lin Q, Wang Y. Helicobacter pylori antibiotic resistance profile in Chinese children with upper gastrointestinal symptoms and a literature review for developing personalized eradicating strategies. Front Pharmacol 2024; 15:1392787. [PMID: 38887553 PMCID: PMC11180794 DOI: 10.3389/fphar.2024.1392787] [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: 02/28/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
Background: H. pylori (Helicobacter pylori) infections typically occur in early childhood. Although the prevalence of H. pylori in children is lower than that in adults, the eradication rate of this infection in children is relatively low because of resistance. In this study, we analyzed personalized treatment strategies to achieve treatment goals based on H. pylori resistance characteristics. This retrospective single-center study was conducted between January 2019 and December 2022 and enrolled 1,587 children who presented with upper gastrointestinal symptoms and underwent endoscopy. H. pylori culturing and antimicrobial susceptibility testing were performed. Results: Culture-positive results for H. pylori were obtained in 535 children. The resistance rates to clarithromycin (CLA), metronidazole (MET), and levofloxacin (LEV) were 39.8%, 78.1%, and 20.2%, respectively. None of the isolates were resistant to tetracycline (TET), amoxicillin (AMO), or furazolidone (FZD). Double resistance rates to CLA + MET, CLA + LEV, and MET + LEV were 19.1%, 3.0%, and 5.8%, respectively. Notably, triple-resistant to CLA + MET + LEV was 9.7%. Based on susceptibility tests, individualized triple therapy [proton pump inhibitor (PPI) +AMO + CLA/MET] was selected for 380 children with H. pylori sensitive to MET and/or CLA. In 155 children resistant to CLA and MET, bismuth-based quadruple therapy was recommended; for unable to receive bismuth, concomitant therapy was recommended for 14 children (<8 years of age); triple therapy with TET was recommended for 141 children (>8 years of age), with 43 children (>14 years of age) requiring FZD rather than TET. Conclusion: Resistance to H. pylori in Chinese children was relatively poor. Personalized therapy regimens should be based on susceptibility tests and avoided factors associated with treatment failure.
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Affiliation(s)
- Danli Zhou
- Department of Pharmacy, Affiliated Children’s Hospital of Jiangnan University, Jiangsu University, Wuxi, China
| | - Wuyu Wang
- Department of Burns and Plastic Surgery, Affiliated Children’s Hospital of Jiangnan University, Jiangsu University, Wuxi, China
| | - Lan Gu
- Department of Gastroenterology, Affiliated Children’s Hospital of Jiangnan University, Jiangsu University, Wuxi, China
| | - Meiling Han
- Department of Pharmacy, Affiliated Children’s Hospital of Jiangnan University, Jiangsu University, Wuxi, China
| | - Wujuan Hao
- Department of Gastroenterology, Affiliated Children’s Hospital of Jiangnan University, Jiangsu University, Wuxi, China
| | - Junfeng Huang
- Department of Gastroenterology, Affiliated Children’s Hospital of Jiangnan University, Jiangsu University, Wuxi, China
| | - Qiong Lin
- Department of Gastroenterology, Affiliated Children’s Hospital of Jiangnan University, Jiangsu University, Wuxi, China
| | - Yan Wang
- Department of Pharmacy, Affiliated Children’s Hospital of Jiangnan University, Jiangsu University, Wuxi, China
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Li C, He L, Wang A, Chen S, Fu P, Wang C. Antibiotic resistance and virulence genes in Helicobacter pylori strains isolated from children in Shanghai, China (2019-2022). Int J Med Microbiol 2024; 315:151622. [PMID: 38776570 DOI: 10.1016/j.ijmm.2024.151622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/07/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The increasing prevalence of antibiotic-resistant Helicobacter pylori strains poses a significant threat to children's health. This study investigated antibiotic resistance rates in Helicobacter pylori strains isolated from children in Shanghai and analyzed the presence of virulence genes in these strains. METHODS We obtained 201 Helicobacter pylori strains from pediatric patients with upper gastrointestinal symptoms who underwent gastrointestinal endoscopy between 2019 and 2022. Subsequently, we performed antibiotic susceptibility tests and virulence gene PCR assays on these strains. RESULTS Helicobacter pylori resistance rates of 45.8%, 15.4%, 1.0%, and 2.5% were detected for metronidazole, clarithromycin, amoxicillin, and levofloxacin, respectively. Among all isolates, 64.7% exhibited resistance to at least one antibiotic. Resistance to metronidazole and clarithromycin increased from 2019 to 2022. The predominant vacA gene subtype was vacA s1a/m2. The prevalence of vacA m2 and dupA exhibited an upward trend, while oipA presented a decreasing trend from 2019 to 2022. The prevalence of dupA was significantly higher in gastritis than peptic ulcer disease, and in non-treatment compared to treatment groups. CONCLUSIONS Helicobacter pylori antibiotic resistance remains high in children and has risen in recent years. Therefore, the increasing use of metronidazole and clarithromycin requires increased monitoring in children. No association was observed between antibiotic resistance and virulence gene phenotypes.
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Affiliation(s)
- Chunling Li
- Lab of Microbiology, Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Leiyan He
- Lab of Microbiology, Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Aimin Wang
- Lab of Microbiology, Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Saige Chen
- Lab of Microbiology, Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Pan Fu
- Lab of Microbiology, Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China; Nosocomial Infection Control Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Chuanqing Wang
- Lab of Microbiology, Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China; Nosocomial Infection Control Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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Zeng SY, Wang J, Liu J, Lin MJ, Lin BS, Ding YM, Kong QZ, Zhang WL, Duan M, Han ZX, Li YY, Zuo XL, Li YQ. Efficacy and safety of a 14-day modified concomitant therapy for refractory Helicobacter pylori infection: a pilot study. J Gastroenterol Hepatol 2023; 38:2097-2103. [PMID: 37702104 DOI: 10.1111/jgh.16348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/11/2023] [Accepted: 08/26/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND AND AIM After three treatment failures, Helicobacter pylori infection is deemed refractory as antibiotic treatment options become significantly limited. This study evaluated the efficacy and safety of a 14-day modified concomitant therapy for managing refractory H. pylori infection. METHODS Patients who had failed to respond to three or more rounds of H. pylori therapies were recruited for this study. They received a 14-day modified concomitant therapy, including esomeprazole 40 mg, amoxicillin 1000 mg, and furazolidone 100 mg twice daily and tetracycline 500 mg four times daily. Demographic data, adverse events, and patient compliance were recorded. The presence of H. pylori was reevaluated 6 weeks following treatment. Eradication rate was assessed as the primary outcome. RESULTS Overall, 59 participants received the 14-day modified concomitant therapy. In the intention-to-treat and per-protocol analyses, the eradication rate was 84.7% (50/59) and 89.3% (50/56), respectively. H. pylori was successfully isolated from 75.0% (12/16) of patients. The resistance rate of H. pylori to metronidazole, levofloxacin, and clarithromycin was 91.7% (11/12), 58.3% (7/12), and 50.0% (6/12), respectively. Resistance to amoxicillin, furazolidone, or tetracycline was not observed. The frequency of adverse events was 35.6% (21/59), with no serious adverse events reported. CONCLUSION The 14-day modified concomitant therapy appears to be appropriate for refractory H. pylori infection and is particularly promising for the Chinese population. A randomized controlled trial is warranted to verify its efficacy, especially in the current environment of increasing antibiotic resistance.
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Affiliation(s)
- Shu-Yan Zeng
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Juan Wang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Hospital Development Center of Qingdao Municipal Health Commission, Qingdao, Shandong, China
| | - Jing Liu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Min-Juan Lin
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Bo-Shen Lin
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yu-Ming Ding
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Qing-Zhou Kong
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Wen-Lin Zhang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Miao Duan
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zhong-Xue Han
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yue-Yue Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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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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Karbalaei M, Keikha M, Talebi Bezmin Abadi A. Prevalence of Primary Multidrug-resistant Helicobacter pylori in Children: A Systematic Review and Meta-analysis. Arch Med Res 2022; 53:634-640. [PMID: 36089418 DOI: 10.1016/j.arcmed.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The emergence and global spread of multidrug-resistant Helicobacter pylori (MDR H. pylori) is a major health problem in children, which can increase the risk of serious complications such as gastric cancer. The aim of this study was to determine the prevalence of primary MDR H. pylori in children via a comprehensive systematic literature review and meta-analysis. METHODS All potential studies were collected from international databases like: ISI Web of Science, Embase, PubMed, Google Scholar, and Scopus from 2011-July 24, 2022. Ultimately, primary MDR H. pylori in children was measured as an event rate with corresponding 95% confidence intervals. RESULTS A total of 19 studies met the inclusion criteria. The overall prevalence of primary MDR H. pylori in children was measured at 6.0% (95% CI: 3.1-11.6); There was a significant difference in primary MDR H. pylori resistance rates between Asian populations and Western countries. CONCLUSIONS The global spread of MDR H. pylori strains could significantly limit the options of anti-H. pylori treatment regimens. The frequency of primary MDR H. pylori infection differs between various geographical regions. Thus, drug susceptibility testing and the eradication of H. pylori infection can effectively reduce and control the spread of H. pylori antibiotic resistance throughout the world.
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Affiliation(s)
- Mohsen Karbalaei
- Department of Microbiology and Virology, School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Masoud Keikha
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Talebi Bezmin Abadi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Antibiotic resistance of Helicobacter pylori isolated from children in Chongqing, China. Eur J Pediatr 2022; 181:2715-2722. [PMID: 35469031 DOI: 10.1007/s00431-022-04456-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/14/2022]
Abstract
The resistance of Helicobacter pylori (H. pylori) to antibiotics has been increasing worldwide and varies across different geographic areas and times. Limited studies reported the prevalence of antibiotic resistance and its related gene mutations in children in Chongqing, a city located in southwest China. We collected 112 H. pylori strains isolated from gastric biopsies of 156 children at Children's Hospital of Chongqing Medical University and calculated resistance rates of these strains to six antibiotics. The A2143G and A2142G mutations in 23S rRNA gene, which are related to clarithromycin resistance, and Asn87 and Asp91 mutations in gyrA gene, which are related to levofloxacin resistance, were investigated in 102 strains. The resistance rates to clarithromycin, metronidazole, and levofloxacin were 47.3% (53/112), 88.4% (99/112), and 18.8% (21/112), respectively. No resistance to amoxicillin, tetracycline, and furazolidone was observed. Dual and triple resistance percentages were 37.5% (42/112) and 10.7% (12/112), respectively. The detection rate of A2143G mutation in 23S rRNA gene was 83.3% (40/48). The detection rates of mutations of Asn87 and Asp91 in gyrA gene were 52.6% (10/19) and 36.8% (7/19), respectively. Conclusion: The prevalence of H. pylori resistance to clarithromycin, metronidazole, and levofloxacin was high in children in Chongqing, China. The A2143G mutation was detected in most clarithromycin-resistant strains, and Asn87 and Asp91 of gyrA mutation points were common in levofloxacin-resistant strains. In clinical practice, anti-H. pylori therapy should be individualized based on a susceptibility test. What is Known: • The resistance of H. pylori to antibiotics changes with the geographic areas and that in Asia the resistance rate is high. • Mutation plays a vital role in antibiotics resistance of H. pylori. What is New: • High resistance rates to single and multiple antibiotics in children of Chongqing, a city located in southwest China, were observed. • Molecular assays showed good conformance with susceptibility test results to direct antibiotic resistance of H. pylori.
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Zhang Y, Meng F, Jin J, Wang J, Gu BB, Peng JB, Ye LP. Ninety-four thousand-case retrospective study on antibacterial drug resistance of Helicobacter pylori. World J Clin Cases 2021; 9:10838-10849. [PMID: 35047595 PMCID: PMC8678885 DOI: 10.12998/wjcc.v9.i35.10838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/01/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The resistance rate to antibacterial drugs is the key inhibitor of Helicobacter pylori (H. pylori) eradication treatment.
AIM To evaluate the prevalence and drug resistance of H. pylori based on big data.
METHODS Gastric mucosal specimens were collected from naive patients undergoing upper gastrointestinal endoscopy for H. pylori culture and antimicrobial susceptibility testing (AST), including clarithromycin, levofloxacin, metronidazole and amoxicillin. Every 10 years of age was grouped as an age group. The H. pylori infection and resistance were explored based on the age group and gender.
RESULTS The number of H. pylori-positive specimen was 94509 in 283823 gastric mucosal specimens, with an infection rate of 33.30%. The infection rate increased with age, and males had a higher infection rate than females. The average resistance rate of H. pylori to amoxicillin and metronidazole was 0.21% and 93.72%, which remained stable. The average resistance rate to clarithromycin was 23.99% with an increasing trend from 14.43% to 38.24%. The average resistance rate to levofloxacin was 30.29%, which increased from 17.07% to 39.42% and mostly stabilized after 2017. The resistance rate of H. pylori increased with age, except amoxicillin. H. pylori in females are at higher risk of resistance to metronidazole, but not to amoxicillin, regardless of the age group. Meanwhile, H. pylori in females are at higher risk of resistance to levofloxacin and clarithromycin in the 21-50 age group. The single, dual, triple and quadruple-drug resistance rate was 54.59%, 29.03%, 11.71% and 0.11%, respectively.
CONCLUSION The resistance of H. pylori in Taizhou city is serious. Guided by the consensus report, individualized treatment based on AST is recommended.
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Affiliation(s)
- Yu Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Linhai 318000, Zhejiang Province, China
| | - Fei Meng
- Department of Research Service, Zhiyuan Medical Inspection Institute CO., LTD, Hangzhou 310030, Zhejiang Province, China
| | - Jie Jin
- Department of Research Service, Zhiyuan Medical Inspection Institute CO., LTD, Hangzhou 310030, Zhejiang Province, China
| | - Jun Wang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Linhai 318000, Zhejiang Province, China
| | - Bin-Bin Gu
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Linhai 318000, Zhejiang Province, China
| | - Jin-Bang Peng
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Linhai 318000, Zhejiang Province, China
| | - Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Linhai 318000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou 318000, Zhejiang Province, China
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Zhao Q, Xin L, Liu Y, Liang C, Li J, Jian Y, Li H, Shi Z, Liu H, Cao W. Current Landscape and Future Perspective of Oxazolidinone Scaffolds Containing Antibacterial Drugs. J Med Chem 2021; 64:10557-10580. [PMID: 34260235 DOI: 10.1021/acs.jmedchem.1c00480] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The widespread use of antibiotics has made the problem of bacterial resistance increasingly serious, and the study of new drug-resistant bacteria has become the main direction of antibacterial drug research. Among antibiotics, the fully synthetic oxazolidinone antibacterial drugs linezolid and tedizolid have been successfully marketed and have achieved good clinical treatment effects. Oxazolidinone antibacterial drugs have good pharmacokinetic and pharmacodynamic characteristics and unique antibacterial mechanisms, and resistant bacteria are sensitive to them. This Perspective focuses on reviewing oxazolidinones based on the structural modification of linezolid and new potential oxazolidinone drugs in the past 10 years, mainly describing their structure, antibacterial activity, safety, druggability, and so on, and discusses their structure-activity relationships, providing insight into the reasonable design of safer and more potent oxazolidinone antibacterial drugs.
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Affiliation(s)
- Qianqian Zhao
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an 710021, P. R. China
| | - Liang Xin
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an 710021, P. R. China.,Xi'an Xuri Shengchang Pharmaceutical Technology Co., Ltd., High-tech Zone, Xi'an 710075, P. R. China
| | - Yuzhi Liu
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an 710021, P. R. China
| | - Chengyuan Liang
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an 710021, P. R. China
| | - Jingyi Li
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an 710021, P. R. China
| | - Yanlin Jian
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an 710021, P. R. China
| | - Han Li
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an 710021, P. R. China
| | - Zhenfeng Shi
- Department of Urology Surgery Center, Xinjiang Uyghur People's Hospital, Urumqi 830002, P. R. China
| | - Hong Liu
- Zhuhai Jinan Selenium Source Nanotechnology Co., Ltd., Hengqin New Area, Zhuhai 519030, P. R. China
| | - Wenqiang Cao
- Zhuhai Jinan Selenium Source Nanotechnology Co., Ltd., Hengqin New Area, Zhuhai 519030, P. R. China
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Cui R, Song Z, Suo B, Tian X, Xue Y, Meng L, Niu Z, Jin Z, Zhang H, Zhou L. Correlation Analysis Among Genotype Resistance, Phenotype Resistance and Eradication Effect of Helicobacter pylori. Infect Drug Resist 2021; 14:1747-1756. [PMID: 34012273 PMCID: PMC8127322 DOI: 10.2147/idr.s305996] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/15/2021] [Indexed: 12/13/2022] Open
Abstract
Background It has not been fully confirmed whether the detection of Helicobacter pylori resistance gene mutation can replace antibiotic drug sensitivity test to guide the clinical individualized treatment. Therefore, we have studied this aspect and discussed the application value of antibiotic sensitivity gene test. Materials and Methods The biopsy specimen of gastric mucosa from the patients examined by endoscopy and positive for rapid urease test were collected continuously for histopathological analysis, H. pylori culture, antibiotic drug sensitivity test (E-test drug sensitivity test), and antibiotic sensitivity gene test (high-throughput nucleotide sequencing). The participants received triple plus bismuth solution eradication treatment (esomeprazole 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and bismuth potassium citrate 220 mg, twice daily for 14 days) for follow-up, and the eradication effect was determined. Results The 551/602 subjects, who met the inclusion criteria, were subjected to culture for H. pylori and antibiotic drug sensitivity determination; among them 506 were cultured successfully. The results showed that the resistance rates of H. pylori were 38.9% for clarithromycin and 31.0% for levofloxacin. In 489 H. pylori strains, the mutations were detected in clarithromycin and levofloxacin resistance genes, indicating the genotype resistance. The resistance genes of clarithromycin and levofloxacin were consistent with phenotype resistance with respect to sensitivity (81.2% and 69.7% for clarithromycin and levofloxacin, respectively) and specificity (88.9% and 93.7% for clarithromycin and levofloxacin, respectively). The eradication rate of H. pylori in the clarithromycin-resistant group was significantly lower than that in the sensitive group (ITT: 52.1% vs 85.0%, P < 0.001). Conclusion A correlation was established between the resistance genes of clarithromycin and levofloxacin and their phenotypic resistance and clinical efficacy. The detection of H. pylori resistance genes has a good clinical application prospect.
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Affiliation(s)
- Rongli Cui
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Zhiqiang Song
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Baojun Suo
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Xueli Tian
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Yan Xue
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Lingmei Meng
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Zhanyue Niu
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Zhu Jin
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Hejun Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Liya Zhou
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
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11
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Li J, Deng J, Wang Z, Li H, Wan C. Antibiotic Resistance of Helicobacter pylori Strains Isolated From Pediatric Patients in Southwest China. Front Microbiol 2021; 11:621791. [PMID: 33574804 PMCID: PMC7870467 DOI: 10.3389/fmicb.2020.621791] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/31/2020] [Indexed: 02/05/2023] Open
Abstract
The number of antibiotics that are appropriate for Helicobacter pylori eradication in children is limited. Profiling regional or population-specific antibiotic resistance is essential in guiding the H. pylori eradication treatment in children. The aim of this study was to evaluate the antibiotic resistance in H. pylori strains isolated from children and adolescents in Southwest China. Gastric biopsies from 157 pediatric patients with or without previous H. pylori eradication treatment were collected for H. pylori culture. Susceptibility to amoxicillin (AML), clarithromycin (CLR), metronidazole (MTZ), levofloxacin (LEV), tetracycline (TET), furazolidone (FZD), and rifampicin (RIF) was determined by E-test or a disk diffusion assay. A total of 87 patients from three ethnic groups (Han/Tibetan/Yi) were H. pylori culture positive (55.4%). The overall resistance rates were 55.2% for CLR, 71.3% for MTZ, 60.9% for RIF, and 18.4% for LEV. No isolate was found to be resistant to AML, TET, and FZD. Among the 53 treatment-naïve pediatric patients, primary resistance rates to clarithromycin, metronidazole, levofloxacin, and rifampicin were 45.3, 73.6, 15.1, and 60.4%, respectively. Among the 34 treatment-experienced patients, secondary resistance rates to clarithromycin, metronidazole, levofloxacin, and rifampicin were 70.6, 67.6, 23.5, and 61.8%, respectively. Isolates exhibiting simultaneous resistance to clarithromycin and metronidazole were 28.3 and 52.9% among the treatment-naïve and treatment-experienced patients, respectively. In conclusion, among pediatric patients in Southwest China, resistance rates were high for clarithromycin, metronidazole, levofloxacin, and rifampicin, whereas nil resistance was found to amoxicillin, tetracycline, and furazolidone. Our data suggest that the standard clarithromycin-based triple therapy should be abandoned as empiric therapy, whereas the bismuth quadruple therapy (bismuth/PPI/amoxicillin/tetracycline) would be suitable as first-line empiric treatment regimen for this pediatric population. Tetracycline and furazolidone may be considered for treating refractory H. pylori infections in adolescent patients.
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Affiliation(s)
- Juan Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Infection Control, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jianjun Deng
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Infection Control, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhiling Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- West China Marshall Research Center for Infectious Diseases, Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Chaomin Wan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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12
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Miqueleiz-Zapatero A, Alba-Rubio C, Domingo-García D, Cantón R, Gómez-García de la Pedrosa E, Aznar-Cano E, Leiva J, Montes M, Sánchez-Romero I, Rodríguez-Díaz JC, Alarcón-Cavero T. First national survey on the diagnosis of Helicobacter pylori infection in Clinical Microbiology Laboratories in Spain. Enferm Infecc Microbiol Clin 2020. [DOI: 10.1016/j.eimce.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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13
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Mascellino MT, Oliva A, Miele MC, De Angelis M, Bruno G, Severi C. Secondary Antibiotic Resistance, Correlation between Genotypic and Phenotypic Methods and Treatment in Helicobacter pylori Infected Patients: A Retrospective Study. Antibiotics (Basel) 2020; 9:E549. [PMID: 32872117 PMCID: PMC7560230 DOI: 10.3390/antibiotics9090549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to evaluate the secondary resistance in Helicobacter pylori (Hp) infected patients who had failed a first-line therapy, and to compare the genotypic tests performed directly on gastric samples with phenotypic tests performed on culture media. The eradication rate of patients treated with bismuth quadruple therapy (BQT) is also evaluated. A total of 80 positive specimens were retrospectively examined. Antibiotic susceptibility testing of Hp strains was performed by E-test, whereas a molecular commercially available method was used for detecting the mutations involved in clarithromycin and levofloxacin resistance. High resistance levels to metronidazole and clarithromycin (61.6% and 35%, respectively) and worrying resistance levels to levofloxacin (15%) were found phenotypically. Multiple resistance to two or three antibiotics was observed as well. The polymorphism A2143G on clarithromycin 23S rRNA gene was found in 34/80 (42.5%) isolates including 10 mixed infections (29%), whereas 28/80 (35%) strains were resistant phenotypically. Levofloxacin resistance corresponded to 30% by PCR and 15% by E-test (statistically significant, p < 0.05). The knowledge of clarithromycin and levofloxacin resistance is crucial to establish an appropriate therapy in different geographical areas. The genetic methods were superior to phenotypic techniques in the absence of live bacteria or for identifying mixed infections that may lead to a resistance underestimation. The BQT eradication rate was effective (90%).
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Affiliation(s)
- Maria Teresa Mascellino
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (A.O.); (M.C.M.); (M.D.A.)
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (A.O.); (M.C.M.); (M.D.A.)
| | - Maria Claudia Miele
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (A.O.); (M.C.M.); (M.D.A.)
| | - Massimiliano De Angelis
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy; (A.O.); (M.C.M.); (M.D.A.)
| | - Giovanni Bruno
- Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy; (G.B.); (C.S.)
| | - Carola Severi
- Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy; (G.B.); (C.S.)
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14
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Lok CH, Zhu D, Wang J, Ren YT, Jiang X, Li SJ, Zhao XY. Phenotype and Molecular Detection of Clarithromycin and Levofloxacin Resistance in Helicobacter pylori Clinical Isolates in Beijing. Infect Drug Resist 2020; 13:2145-2153. [PMID: 32753910 PMCID: PMC7352368 DOI: 10.2147/idr.s249370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Understanding drug resistance is important in drug selection for Helicobacter pylori (H. pylori) eradication, and drug resistance data are lacking in Beijing. Purpose This cross-sectional study aimed to isolate H. pylori from patients with gastroduodenal diseases and to analyze drug resistance to clarithromycin (CLA) and levofloxacin (LEV), which are used frequently in China. Patients and Methods One hundred and seventy-six patients with gastroduodenal diseases undergoing gastroduodenoscopy were selected by convenient sampling. Gastric mucosa samples were cultured and sub-cultured using a new medium broth. Active H. pylori strains were confirmed by microscopy observation as Gram-negative curved bacilli with positive test results for urease, oxidase, and catalase, and H. pylori 16S rRNA amplification by polymerase chain reaction (PCR). CLA and LEV resistance was identified by minimum inhibitory concentration (MIC) tests and sequencing of 23S rRNA, gyrA, and gyrB genes. Results From the 176 clinical samples, 112 (112/176, 63.6%) were confirmed with H. pylori infection and 65 (65/176, 36.9%) active H. pylori strains were obtained and further confirmed by MIC assay. Overall, the rates of CLA-resistant and LEV-resistant mutations in the 112 samples were 50.9% and 33.0%, respectively. Mutation related to CLA resistance was A2143G in the 23S rRNA gene and mutations associated with LEV resistance were N87K, D91G, and D91Y in the gyrA gene. Of 112 samples, 22 (19.6%) presented dual resistance to CLA and LEV. Resistance of the H. pylori strains to CLA (r=0.846, P<0.001) and LEV (r=0.936, P<0.001) had a strong correlation in phenotypic and genotypic level. Conclusion The results indicated that resistance of CLA and LEV is severe among patients with gastroduodenitis. A good consistency could be found as to drug resistance between genotypic or phenotypic assay, suggested extending the detection of H. pylori drug resistance from the MIC method to a genotypic assay.
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Affiliation(s)
- Chong-Hou Lok
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Dong Zhu
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Jia Wang
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Yu-Tang Ren
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Xuan Jiang
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Shu-Jun Li
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Xiu-Ying Zhao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
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15
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Miqueleiz-Zapatero A, Alba-Rubio C, Domingo-García D, Cantón R, Gómez-García de la Pedrosa E, Aznar-Cano E, Leiva J, Montes M, Sánchez-Romero I, Rodríguez-Díaz JC, Alarcón-Cavero T. First national survey of the diagnosis of Helicobacter pylori infection in Clinical Microbiology Laboratories in Spain. Enferm Infecc Microbiol Clin 2020; 38:410-416. [PMID: 31987710 DOI: 10.1016/j.eimc.2019.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The aim of this study was to know, through a national survey, the methods and techniques used for the diagnosis of Helicobacter pylori (Hp) in the different Clinical Microbiology Services/Laboratories in Spain, as well as antibiotic resistance data. METHODS The survey requested information about the diagnostic methods performed for Hp detection in Clinical Microbiology laboratories, including serology, stool antigen, culture from gastric biopsies, and PCR. In addition, the performance of antibiotic susceptibility was collected. Data on the number of samples processed in 2016, positivity of each technique and resistance data were requested. The survey was sent by email (October-December 2017) to the heads of 198 Clinical Microbiology Laboratories in Spain. RESULTS Overall, 51 centers from 29 regions answered the survey and 48/51 provided Hp microbiological diagnostic testing. Concerning the microbiological methods used to diagnose Hp infection, the culture of gastric biopsies was the most frequent (37/48), followed by stool antigen detection (35/48), serology (19/48) and biopsy PCR (5/48). Regarding antibiotic resistance, high resistance rates were observed, especially in metronidazole and clarithromycin (over 33%). CONCLUSION Culture of gastric biopsies was the most frequent method for detection of Hp, but the immunochromatographic stool antigen test was the one with which the largest number of samples were analyzed. Nowadays, in Spain, it concerns the problem of increased antibiotic resistance to 'first-line' antibiotics.
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Affiliation(s)
- Ana Miqueleiz-Zapatero
- Servicio de Microbiología, Hospital Universitario de la Princesa e Instituto Investigación Princesa (IP), Madrid, España; Servicio de Microbiología, Complejo Hospitalario de Navarra, Pamplona, España.
| | - Claudio Alba-Rubio
- Servicio de Microbiología, Hospital Universitario de la Princesa e Instituto Investigación Princesa (IP), Madrid, España; Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, España
| | - Diego Domingo-García
- Servicio de Microbiología, Hospital Universitario de la Princesa e Instituto Investigación Princesa (IP), Madrid, España
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - Elia Gómez-García de la Pedrosa
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | | | - José Leiva
- Servicio de Microbiología, Clínica Universidad de Navarra e Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | - Milagrosa Montes
- Servicio de Microbiología, Hospital Universitario Donostia - Instituto Biodonostia, San Sebastián, España
| | - Isabel Sánchez-Romero
- Servicio de Microbiología, Hospital Universitario Puerta del Hierro, Majadahonda, España
| | | | - Teresa Alarcón-Cavero
- Servicio de Microbiología, Hospital Universitario de la Princesa e Instituto Investigación Princesa (IP), Madrid, España
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16
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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.
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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
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17
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Lu HH, Lai FP, Lo HY, Sheu BS, Yang YJ. Increasing antimicrobial resistance to clarithromycin and metronidazole in pediatric Helicobacter pylori infection in southern Taiwan: A comparison between two decades. Helicobacter 2019; 24:e12633. [PMID: 31295754 DOI: 10.1111/hel.12633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/01/2019] [Accepted: 06/15/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Antimicrobial resistance of Helicobacter pylori reduces the eradication rate. This study aimed to investigate changes in antimicrobial susceptibility of H pylori isolated from children in Taiwan in the past two decades. METHODS This study enrolled children receiving esophagogastroduodenoscopy for upper gastrointestinal diseases in a national tertiary referring hospital from 1998 to 2018. H pylori infection was diagnosed by culture. The minimal inhibitory concentrations (MICs) of antibiotics were tested using the E test. The antibiotic resistance rates and MICs of amoxicillin, clarithromycin, metronidazole, levofloxacin, and tetracycline were compared between 1998-2008 and 2009-2018. RESULTS A total of 70 Helicobacter pylori isolates (29 from 1998 to 2008 and 41 from 2009 to 2018) were identified. The esophagogastroduodenoscopy findings included duodenal ulcers (n = 31), gastric ulcers (n = 9), and gastritis (n = 30). The overall antimicrobial resistance rates of clarithromycin and metronidazole were 22.9% and 21.4%, respectively. The dual resistance rate of clarithromycin and metronidazole was 10%. Resistance rates of levofloxacin and amoxicillin were 8.3% and 2.9%, respectively. None of the isolates were resistant to tetracycline. Compared with the isolates from 1998 to 2008, those from 2009 to 2018 had higher MICs and resistance rates of clarithromycin (26.8% vs 17.2%, P = 0.35) and metronidazole (26.8% vs 13.8%, P = 0.19), but not levofloxacin (9.8% vs 5.3%, P = 1.0) or coresistance to clarithromycin and metronidazole (12.2% vs 6.9%, P = 0.69). CONCLUSIONS The antimicrobial resistance rates of pediatric H pylori isolates to clarithromycin and metronidazole increased during the past decade. The selection of antimicrobial agents other than clarithromycin and metronidazole is crucial to increase pediatric H pylori eradication rates.
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Affiliation(s)
- Hsiao-Han Lu
- Departments of Pediatrics, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Fu-Ping Lai
- Departments of Pediatrics, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Yu Lo
- Departments of Pediatrics, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan.,Institutes of Clinical Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Bor-Shyang Sheu
- Institutes of Clinical Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan.,Departments of Internal Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Jong Yang
- Departments of Pediatrics, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan.,Institutes of Clinical Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan
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18
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Guo C, Liu F, Zhu L, Wu F, Cui G, Xiong Y, Wang Q, Yin L, Wang C, Wang H, Wu X, Zhang Z, Chen Z. Analysis of culturable microbiota present in the stomach of children with gastric symptoms. Braz J Microbiol 2018; 50:107-115. [PMID: 30637659 DOI: 10.1007/s42770-018-0030-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/05/2018] [Indexed: 12/17/2022] Open
Abstract
Despite extensive studies on the gastric microbiota, including Helicobacter pylori and non-H. pylori, the bacterial composition in children remains unknown. In this study, we analyzed the culturable gastric bacteria in stomach biopsies from 346 children aged 1-15 years affected by gastric diseases. H. pylori and non-H. pylori were identified by specific PCR and 16S rDNA sequencing, respectively. Antibiotic susceptibilities of H. pylori and non-H. pylori were tested by the E-test and disk diffusion methods, respectively. Rapid diagnosis was also performed by H. pylori-specific PCR. Twenty-two H. pylori strains were obtained from culture, and 92 biopsies were positive by H. pylori-specific PCR. The positive rate was higher in boys (40.3%) than in girls (23.3%) (P = 0.001). Resistance rates of 22 H. pylori strains were as follows: metronidazole, 86.4%; tetracycline, 22.7%; amoxicillin, 22.7%; levofloxacin, 31.8%; clarithromycin, 36.4%. Ten isolates were multidrug-resistant. Additionally, among 366 non-H. pylori strains, 204 exhibited urease activity. Non-H. pylori resistance rates were as follows: metronidazole, 94.8%; tetracycline, 26.2%; amoxicillin, 42.6%; levofloxacin, 15.3%; clarithromycin, 46.7%. Our results showed that children with gastric disorders harbor stomach bacteria with urease activity or nitrate reductase activity. Further studies will determine the effects of non-H. pylori bacteria in gastric diseases.
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Affiliation(s)
- Changcheng Guo
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China
| | - Fang Liu
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China
| | - Li Zhu
- Clinical Medical School of Maternal and Child Affiliated to Guizhou Medical University, No.63 South Ruijin Road, Guiyang, 550003, Guizhou, China
| | - Fangcao Wu
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China
| | - Guzhen Cui
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China
| | - Yan Xiong
- Clinical Medical School of Maternal and Child Affiliated to Guizhou Medical University, No.63 South Ruijin Road, Guiyang, 550003, Guizhou, China
| | - Qiong Wang
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China
| | - Lin Yin
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China
| | - Caixia Wang
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China
| | - Huan Wang
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China
| | - Xiaojuan Wu
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China
| | - Zhengrong Zhang
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China
| | - Zhenghong Chen
- School of Basic Medical Science, Key Laboratory of Medical microbiology and parasitology of Education Department of Guizhou, Guizhou Medical University, No.1 South Dongqing Road, Guiyang, 550025, China. .,Department of Microbiology, School of Basic Medical Science, Guizhou Medical University, Guiyang, China.
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Xu B, Ding X, Wu Y, Cui L, Qian P, Wang D, Zhao Y. Synthesis and antibacterial activity of oxazolidinone derivatives containing nitro heteroaromatic moiety. Chem Res Chin Univ 2018. [DOI: 10.1007/s40242-018-7302-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Zhang SH, Zhu X, Li BM, Li H. The effect of virulence genotypes of Helicobacter pylori on eradication therapy in children. Saudi J Gastroenterol 2018; 24:249-254. [PMID: 29652033 PMCID: PMC6080151 DOI: 10.4103/sjg.sjg_579_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIM It is important to eradicate Helicobacter pylori at an early stage in patients during childhood to potentially prevent the development of H. pylori-related diseases. Studies have demonstrated that the virulence genotype of H. pylori influences the efficacy of eradication therapy. The efficacy of triple therapy has decreased significantly, which has seriously affected the clinical outcome of children with H. pylori infection. In this study we aimed to investigate the influence of virulence genotypes of H. pylori on triple eradication therapy in children. PATIENTS AND METHODS H. pylori strains were isolated from the gastric antrum mucosa in children with upper gastrointestinal symptoms. Polymerase chain reaction (PCR) was conducted to determine the H. pylori cagA, vacA, and iceA genotypes. All patients with H. pylori infection were administered 14-day triple therapy. After drug withdrawal for at least 4 weeks, the 13C-urea breath test (13C-UBT) was used to observe the therapeutic effect of H. pylori eradication. The eradication rates were evaluated by intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS A total of 107 patients were enrolled in this study. Nine patients were lost to follow-up, and 98 patients were administered eradication therapy. Based on ITT and PP analyses, the H. pylori eradication rate was 64.5% (69/107) and 70.4% (69/98), respectively. Among the successful eradication groups, the cagA-positive, vacA s1a, vacA s1c, vacA m1, vacA m2, iceA 1, and iceA 2 genes were identified in 72.8%, 68.1%, 76.9%, 60.0%, 74.6%, 71.8%, and 75.0% of strains, respectively. Of the unsuccessful eradication groups, the cagA-positive, vacA s1a, vacA s1c, vacA m1, vacA m2, iceA 1, and iceA 2 genes were identified in 27.2%, 31.9%, 23.1%, 40.0%, 25.4%, 28.2%, and 25.0% of strains, respectively. No statistically significant differences were noted in the detection rate of the H. pylori genotypes between the H. pylori successful and unsuccessful eradication groups (P > 0.05). CONCLUSIONS The cagA, vacA, and iceA genotypes of H. pylori are not associated with the efficacy of omeprazole-based triple therapy on the eradication of H. pylori infection in children.
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Affiliation(s)
- Shuang-Hong Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
| | - Xuan Zhu
- Department of Gastroenterology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China,Address for correspondence: Dr. Xuan Zhu, Department of Gastroenterology, The First Affiliated Hospital, Nanchang University, 17 Yongwaizheng Street, Nanchang, - 330006, Jiangxi Province, China. E-mail:
| | - Bi-Min Li
- Department of Gastroenterology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
| | - Hong Li
- Central Laboratory, Children's Hospital of Jiangxi, Nanchang, Jiangxi Province, China
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Abstract
Helicobacter pylori infection in children differs from that in adults, from the point of view of epidemiology, host response, clinical features, related diseases, and diagnosis, as well as treatment strategies. The prevalence of H. pylori infection, in both children and adults, is decreasing in the Western World as well as in some developing countries, which contrasts with the increase in childhood asthma and allergic diseases. Recurrent abdominal pain is not specific during H. pylori infection in children. The role of H. pylori infection and failure to thrive, children's growth, type I diabetes mellitus (T1DM) and celiac disease remains controversial. The main initial diagnosis is based on upper digestive endoscopy with biopsy-based methods. Nodular gastritis may be a pathognomonic endoscopic finding of childhood H. pylori infection. The infection eradication control is based on validated noninvasive tests. The main cause of treatment failure of H. pylori infection is its clarithromycin resistance. We recommend standard antibiotic susceptibility testing of H. pylori in pediatric patients prior to the initiation of eradication therapy. H. pylori treatment in children should be based on an evaluation of the rate of eradication in the local population, a systematic use of a treatment adapted to the susceptibility profile and a treatment compliance greater than 90%. The last meta-analysis in children did not show an advantage for sequential therapy when compared to a 14-day triple therapy. Finally, the high rate of antibiotic resistance responsible for therapy failure in recent years justifies the necessity of a novel vaccine to prevent H. pylori infection in children.
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Affiliation(s)
- Nicolas Kalach
- Department of Paediatrics, Saint Antoine Paediatric Hospital, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University of Lille, Lille, France
| | - Patrick Bontems
- Pediatric Gastroenterology-Hepatology, Queen Fabiola Children's University Hospital, Brussels, Belgium
| | - Josette Raymond
- Department of Microbiology, Cochin Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), University Paris Descartes, Paris, France
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Abstract
This review summarizes important studies regarding Helicobacter pylori therapy published from April 2016 to April 2017. The main themes that emerge involve studies assessing the efficacy of bismuth and nonbismuth quadruple regimens. While in recent years, much of the emphasis on the use of bismuth has focussed on its utility in a second-line setting, an increasing number of studies this year have shown excellent efficacy in first-line therapy. The efficacy of bismuth as a second-line after sequential and concomitant therapy was particularly noteworthy. Antibiotic resistance was more intensely studied this year than for a long time, and definite trends are presented regarding an increase in resistance, including the fact that clarithromycin resistance in particular is now at a level where the continued use of clarithromycin triple therapy first-line as a mainstream treatment is not recommended. Another exciting trend to emerge this year is the utility of vonoprazan as an alternative to PPI therapy, especially in resistant and difficult-to-treat groups.
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Affiliation(s)
- Anthony O'Connor
- Department of Gastroenterology, Tallaght Hospital/Trinity College Dublin, Dublin, Ireland
| | | | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Colm O'Morain
- Department of Gastroenterology, Tallaght Hospital/Trinity College Dublin, Dublin, Ireland
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