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Mitev S, Marinova C, Spassova Z. A Colorful Conundrum: Dark Urine in a Patient With Inflammatory Bowel Disease. Gastroenterology 2024:S0016-5085(24)00249-X. [PMID: 38452825 DOI: 10.1053/j.gastro.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Stefan Mitev
- Gastroenterology Clinic, University Hospital St Ivan Rilski, Sofia, Bulgaria.
| | - Cvetelina Marinova
- Gastroenterology Clinic, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Zoya Spassova
- Gastroenterology Clinic, University Hospital St Ivan Rilski, Sofia, Bulgaria
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Jonaitis L, Marković S, Farkas K, Gheorghe L, Krznarić Ž, Salupere R, Mokricka V, Spassova Z, Gatev D, Grosu I, Lijović A, Mitrović O, Saje M, Schafer E, Uršič V, Roblek T, Drobne D. Intravenous versus subcutaneous delivery of biotherapeutics in IBD: an expert's and patient's perspective. BMC Proc 2021; 15:25. [PMID: 34879868 PMCID: PMC8654488 DOI: 10.1186/s12919-021-00230-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Several biologic treatments are available in addition to intravenous also in subcutaneous form for treatment of chronic diseases. Benefits of the subcutaneous application of drugs include self-administration by the patient, shorter time of application process with less infusion related adverse events and consequently lower healthcare costs. With appropriate education and support patients are able to administer their treatments at home. This leads to improvement of quality of life, reduction of time needed to travel to the healthcare institution and consequently also reduces costs also for the patient. Over one million residents in the USA and 2.5 million in Europe are estimated to have inflammatory bowel disease (IBD), with substantial costs for health care. These estimates do not factor in the ‘real’ price of IBD, which can impede career aspirations, instil social stigma and impair quality of life in patients. The Virtual Community Meeting, which offered an exchange of experience and opinions from healthcare professionals who are active in treating IBD, and patients with this chronic disease, revealed in-depth arguments and answers to some essential questions: which patients prefer subcutaneous over intravenous dosing; which patients continue to favour intravenous infusions; what are the limitations regarding both applications; what is the patient’s role in therapeutical decision-making and how does IBD affect the patient’s work, finances and quality of life? The aim of this article is to discuss the differences between subcutaneous and intravenous dosing from the health-economic, scientific, and personal perspectives. The meeting offered strong confirmation that most of the patients and healthcare professionals prefer subcutaneous over intravenous drug administration but emphasise the management of risks associated with treatment compliance. Patient education provided by the IBD team in this regard is mandatory. Quality of life of patients is poorer during active disease, but the findings that it can improve over time, including as a result of home- or self-administration of biologics, may be encouraging for individuals with this chronic disease.
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Affiliation(s)
- Laimas Jonaitis
- Gastroenterology clinic, Hospital of Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania
| | - Srdjan Marković
- Department of Gastroenterology, University Hospital Medical Center Zvezdara, Dimitrija tucovica 161, Belgrade, 11000, Serbia
| | - Klaudia Farkas
- Department of Gastroenterology, University of Szeged, Kálvária sgt. 57, Szeged, 6725, Hungary
| | - Liana Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Fundeni 258, 022328, Bucharest, Romania
| | - Željko Krznarić
- Department of Gastroenterology, University Hospital Center Zagreb, Kišpatićeva 12, 10 000, Zagreb, Croatia
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tartu, Ludvig Puusepa 8, 50406, Tartu, Estonia
| | - Viktorija Mokricka
- Pauls Stradiņš Clinical University Hospital, 13 Pilsoņu iela, Riga, LV, 1002, Latvia
| | - Zoya Spassova
- Clinic of Gastroenterology, University Hospital "St. Ivan Rilski", 1431, Sofia, Bulgaria
| | - Dimo Gatev
- BABKUK Bulgarian patient organization ( Bulgarian Crohn and Ulcerative Colitis Association), Nikolai Kopernik 28-30, 1000, Sofia, Bulgaria
| | - Isabella Grosu
- Romanian IBD Patient Association, Traian 3, 910040, Calarasi, Romania
| | - Anton Lijović
- Patient Organization HUCUK (Hrvatsko udruženje za Crohnovu bolest i ulcerozni colitis), Ulica Kralja Zvonimira 20, 10 000, Zagreb, Croatia
| | - Olga Mitrović
- Clinic for Gynecology and Obstetrics, University Clinical Centar of Serbia, Koste Todorovica 26, Belgrade, 11000, Serbia
| | - Mateja Saje
- Inflammatory Bowel Disease Association (Društvo za kronično vnetno črevesno bolezen), Ljubljanska ulica 5, 2000, Maribor, Slovenia
| | - Eszter Schafer
- Department of Gastroenterology, Military Hospital Budapest, Podmaniczky u. 111, Budapest, 1062, Hungary
| | - Viktor Uršič
- Takeda Pharmaceuticals d.o.o, Bleiweisova cesta 30, 1000, Ljubljana, Slovenia
| | - Tina Roblek
- Takeda Pharmaceuticals d.o.o, Bleiweisova cesta 30, 1000, Ljubljana, Slovenia
| | - David Drobne
- University medical Centre Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia. .,Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
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Velikova T, Kyurkchiev D, Spassova Z, Karakolev I, Ivanova-Todorova E, Altankova I, Stanilova S. Retraction notice to "Alterations in cytokine gene expression profile in colon mucosa of inflammatory bowel disease patients on different therapeutic regimens" [Cytokine 92 (2017) 12-19]. Cytokine 2020; 129:155018. [PMID: 32089404 DOI: 10.1016/j.cyto.2020.155018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Tsvetelina Velikova
- Department of Clinical Laboratory and Clinical Immunology - Medical University of Sofia, University Hospital St. Ivan Rilski, bul. Acad. Ivan Evst. Geshov 15, Sofia 1431, Bulgaria.
| | - Dobroslav Kyurkchiev
- Department of Clinical Laboratory and Clinical Immunology - Medical University of Sofia, University Hospital St. Ivan Rilski, bul. Acad. Ivan Evst. Geshov 15, Sofia 1431, Bulgaria
| | - Zoya Spassova
- Department of Internal Medicine, Medical University of Sofia, Clinic of Gastroenterology, University Hospital St. Ivan Rilski, Acad. Ivan Evst. Geshov 15 Blvd., Sofia 1431, Bulgaria
| | - Iliya Karakolev
- Department of Molecular Biology, Immunology and Medical Genetics, Medical Faculty, Trakia University, Armeiska 11 Str., Stara Zagora 6000, Bulgaria
| | - Ekaterina Ivanova-Todorova
- Department of Clinical Laboratory and Clinical Immunology - Medical University of Sofia, University Hospital St. Ivan Rilski, bul. Acad. Ivan Evst. Geshov 15, Sofia 1431, Bulgaria
| | - Iskra Altankova
- University Hospital Lozenets, Sofia University, ul. Kozyak 1, Sofia, Bulgaria
| | - Spaska Stanilova
- Department of Molecular Biology, Immunology and Medical Genetics, Medical Faculty, Trakia University, Armeiska 11 Str., Stara Zagora 6000, Bulgaria
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Velikova TV, Miteva L, Stanilov N, Spassova Z, Stanilova SA. Interleukin-6 compared to the other Th17/Treg related cytokines in inflammatory bowel disease and colorectal cancer. World J Gastroenterol 2020; 26:1912-1925. [PMID: 32390702 PMCID: PMC7201144 DOI: 10.3748/wjg.v26.i16.1912] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/24/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The connection between inflammatory bowel disease (IBD) and colorectal cancer (CRC) is well-established, as persistent intestinal inflammation plays a substantial role in both disorders. Cytokines may further influence the inflammation and the carcinogenesis process.
AIM To compare cytokine patterns of active IBD patients with early and advanced CRC.
METHODS Choosing a panel of cytokines crucial for Th17/Treg differentiation and behavior, in colon specimens, as mRNA biomarkers, and their serum protein levels.
RESULTS We found a significant difference between higher gene expression of FoxP3, TGFb1, IL-10, and IL-23, and approximately equal level of IL-6 in CRC patients in comparison with IBD patients. After stratification of CRC patients, we found a significant difference in FoxP3, IL-10, IL-23, and IL-17A mRNA in early cases compared to IBD, and IL-23 alone in advanced CRC. The protein levels of the cytokines were significantly higher in CRC patients compared to IBD patients.
CONCLUSION Our findings showed that IL-6 upregulation is essential for both IBD and CRC development until the upregulation of other Th17/Treg related genes (TGFb1, IL-10, IL-23, and transcription factor FoxP3) is a crucial primarily for CRC development. The significantly upregulated IL-6 could be a potential drug target for IBD and prevention of CRC development as well.
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Affiliation(s)
| | - Lyuba Miteva
- Department of Molecular Biology, Immunology and Medical Genetics, Medical Faculty, Trakia University, Stara Zagora 6000, Bulgaria
| | - Noyko Stanilov
- Oncoplastic Unit, University College London Hospital, London 235, United Kingdom
| | - Zoya Spassova
- Clinic of Gastroenterology, University Hospital “St. Ivan Rilski”, Sofia 1431, Bulgaria
| | - Spaska Angelova Stanilova
- Department of Molecular Biology, Immunology and Medical Genetics, Medical Faculty, Trakia University, Stara Zagora 6000, Bulgaria
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Boyanova L, Gergova G, Markovska R, Kandilarov N, Davidkov L, Spassova Z, Mitov I. Primary Helicobacter pylori resistance in elderly patients over 20 years: A Bulgarian study. Diagn Microbiol Infect Dis 2017; 88:264-267. [PMID: 28506722 DOI: 10.1016/j.diagmicrobio.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/26/2017] [Accepted: 05/03/2017] [Indexed: 12/11/2022]
Abstract
We evaluated the antibiotic susceptibility of 233 Helicobacter pylori strains isolated in the period 2011-2016, involving 62 strains from elderly patients aged 66-93years and 171 strains from younger adults. To assess resistance evolution, primary resistance rates in 92 strains from as many patients aged ≥60years in 1996-2003 were compared with those in 85 strains from infected patients in the same age group in 2011-2016. In the patients aged >65years evaluated during the last 6 years, amoxicillin resistance according to EUCAST and prior breakpoints was 1.6 and 0%, respectively. Resistance rates were the same by both breakpoint systems to metronidazole (35.5%), clarithromycin (22.6%), tetracycline (1.6%) and levofloxacin (32.3%). In 2011-2016, there were no significant differences between resistance rates in the subjects aged >65years and the younger adults. Notably, during the last 6 years, double/triple resistance was found in 21.0% of the subjects aged >65years. Moreover, the prevalence of quinolone primary resistance (30.0%) was significantly (3.4-fold) higher than that (8.9%) observed in 1996-2003. Briefly, the presence of both combined resistance and a strikingly high primary levofloxacin resistance in the elderly implies a cautious antibiotic choice for H. pylori eradication. In vitro susceptibility testing of the strains is highly important in this age group. The results can be linked to more frequent comorbidities and co-infection treatment in older compared with younger patients and, additionally, to the national antibiotic consumption. The high prevalence of quinolone resistance in the elderly patients is an alarming finding.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Zdrave street 2, 1431 Sofia, Bulgaria.
| | - Galina Gergova
- Department of Medical Microbiology, Medical University of Sofia, Zdrave street 2, 1431 Sofia, Bulgaria
| | - Rumyana Markovska
- Department of Medical Microbiology, Medical University of Sofia, Zdrave street 2, 1431 Sofia, Bulgaria
| | - Nayden Kandilarov
- Department of General and Hepatobiliary Pancreatic Surgery, Medical University of Sofia, Sofia, Bulgaria
| | - Lyubomir Davidkov
- Department of Gastroenterology, University Hospital St. Ekaterina, Medical University of Sofia, Sofia, Bulgaria
| | - Zoya Spassova
- Department of Gastroenterology, University Hospital St. Ivan Rilski, Medical University of Sofia, Sofia, Bulgaria
| | - Ivan Mitov
- Department of Medical Microbiology, Medical University of Sofia, Zdrave street 2, 1431 Sofia, Bulgaria
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Velikova T, Kyurkchiev D, Spassova Z, Karakolev I, Ivanova-Todorova E, Altankova I, Stanilova S. Alterations in cytokine gene expression profile in colon mucosa of Inflammatory Bowel Disease patients on different therapeutic regimens. Cytokine 2017; 92:12-19. [PMID: 28088612 DOI: 10.1016/j.cyto.2017.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel disease (IBD) is assumed to be caused by genetic and environmental factors that interact together in promoting intestinal immune dysregulation where cytokines have validated role. However, the underlying intimate mechanisms in the human IBD involving cytokines still needs to be supplemented especially in the clinical context. The aim of this study was to investigate the expression of some inflammatory and regulatory cytokines (IL-17A, IL-23, IL-6, TGFβ1, and IL-10) as well as of the transcription factor FoxP3 in mucosal samples of IBD and non-IBD patients. We assessed the mRNA relative quantities (RQ) of the above-mentioned cytokines and the transcription factor FoxP3 in paired colonic samples (inflamed and adjacent normal mucosa) from 37 patients with IBD and in normal mucosal tissue in 12 persons without IBD by performing a qRT-PCR assay and tested the protein levels of target cytokines in serum samples. The patients were divided into three groups: without any therapy (n=10), on 5-ASA (n=11) and on immunosuppressants (Azathioprine±5-ASA/corticosteroids) (n=16) in order to compare the RQ values for each therapeutic group. All investigated genes were found upregulated in the inflamed mucosa of IBD patients in the following order: IL-6>FoxP3>TGFβ1>IL-23>IL-17A>IL-10. We also observed that the gene expression of FoxP3 and IL-6 were substantially higher in the inflamed mucosal tissue of the IBD patients than the adjacent normal mucosa (p=0.035, p=0.03 respectively). Differences between higher mRNA expression of FoxP3 and IL-6 in inflamed tissue were considered significant in patients with ulcerative colitis (UC) (p=0.011, p=0.000 respectively) and with Crohn's disease (CD) (p=0.008, p=0.000 respectively) in comparison to the normal mucosa of non-IBD persons and we found increased TGFβ1 in CD patients alone (p=0.041). Furthermore, IL-6 and TGFβ1 were overexpressed (RQ>10) in non-inflamed mucosa from IBD patients compared to the normal mucosa from the controls. When we compared the gene expression for paired mucosa in the immunosuppressive treated group with the 5-ASA treated group we observed opposite changes in IL-6 and TGFβ1 expression. Additionally, we found higher serum levels of IL-23 (p=0.008), TGFβ1 and IL-6 in IBD patients compared to non-IBD patients. The obtained specific expression profile consisting of IL-6, TGFβ1, IL-10 and FoxP3 may represent a transcriptional hallmark for IBD. Furthermore, we found that treatment with immunosuppressive therapy was more beneficial for driving cytokine expression to restore immune regulation in patients with IBD, unlike the 5-ASA therapy.
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Affiliation(s)
- Tsvetelina Velikova
- Department of Clinical Laboratory and Clinical Immunology, Medical University of Sofia, University Hospital St. Ivan Rilski, bul. Acad. Ivan Evst. Geshov 15, Sofia 1431, Bulgaria.
| | - Dobroslav Kyurkchiev
- Department of Clinical Laboratory and Clinical Immunology, Medical University of Sofia, University Hospital St. Ivan Rilski, bul. Acad. Ivan Evst. Geshov 15, Sofia 1431, Bulgaria
| | - Zoya Spassova
- Department of Internal Medicine, Medical University of Sofia, Clinic of Gastroenterology, University Hospital St. Ivan Rilski, Acad. Ivan Evst. Geshov 15 Blvd., Sofia 1431, Bulgaria
| | - Iliya Karakolev
- Department of Molecular Biology, Immunology and Medical Genetics, Medical Faculty, Trakia University, Armeiska 11 Str., Stara Zagora 6000, Bulgaria
| | - Ekaterina Ivanova-Todorova
- Department of Clinical Laboratory and Clinical Immunology, Medical University of Sofia, University Hospital St. Ivan Rilski, bul. Acad. Ivan Evst. Geshov 15, Sofia 1431, Bulgaria
| | - Iskra Altankova
- University Hospital Lozenets, Sofia University, ul. Kozyak 1, Sofia, Bulgaria
| | - Spaska Stanilova
- Department of Molecular Biology, Immunology and Medical Genetics, Medical Faculty, Trakia University, Armeiska 11 Str., Stara Zagora 6000, Bulgaria
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Boyanova L, Gergova G, Evstatiev I, Spassova Z, Kandilarov N, Yaneva P, Markovska R, Mitov I. Helicobacter pyloriresistance to six antibiotics by two breakpoint systems and resistance evolution in Bulgaria. Infect Dis (Lond) 2015; 48:56-62. [DOI: 10.3109/23744235.2015.1082035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Boyanova L, Ilieva J, Gergova G, Davidkov L, Spassova Z, Kamburov V, Katsarov N, Mitov I. Numerous risk factors for Helicobacter pylori antibiotic resistance revealed by extended anamnesis: a Bulgarian study. J Med Microbiol 2011; 61:85-93. [PMID: 21873378 DOI: 10.1099/jmm.0.035568-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim of this study was to assess risk factors for primary Helicobacter pylori antibiotic resistance by an extended anamnesis. In total, 519 H. pylori strains from untreated symptomatic adults who answered a questionnaire were evaluated. Strain susceptibility was assessed by a breakpoint susceptibility test. Primary resistance rates were 29.5 % for metronidazole, 17.9 % for clarithromycin, 7.3 % for metronidazole+clarithromycin, 4.0 % for tetracycline and 10.8 % for ciprofloxacin. On multivariate analysis, younger (≤65 years) age was an independent predictor for metronidazole resistance. To our knowledge, for the first time, being a member of the health-care profession was revealed as a risk factor for H. pylori resistance to metronidazole and both metronidazole and clarithromycin. Respiratory and urinary tract infections were independent predictors of clarithromycin and ciprofloxacin resistance, respectively. The presence of co-infections was an independent risk factor for clarithromycin, metronidazole and ciprofloxacin resistance. Surprisingly, female sex was the only predictor for tetracycline resistance. The antibiotic resistance rates were not associated with disease type, place of residence, birthplace, educational level, non-steroidal anti-inflammatory drug or proton pump inhibitor use, smoking or dietary factors, such as consumption of coffee, yogurt, green tea, raw garlic, raw onion, honey or meat. There was a trend for higher metronidazole resistance in strains from diabetic patients. In conclusion, the extended anamnesis of H. pylori-positive patients should include data on patient age, sex, whether they are in the health-care profession, co-infections and possibly diabetes to improve the choice of empiric therapy. Tailored treatment based on the extended anamnesis is suggested, and susceptibility testing of the strains is recommended for patients at risk for antibiotic resistance, especially to clarithromycin, fluoroquinolones or both metronidazole and clarithromycin.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria
| | - Juliana Ilieva
- University Department of Social Medicine and Healthcare Management, Medical University of Sofia, Sofia, Bulgaria
| | - Galina Gergova
- Department of Medical Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria
| | - Lubomir Davidkov
- Departments of Gastroenterology and General Surgery, University Hospital St Ekaterina, Sofia, Bulgaria
| | - Zoya Spassova
- Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Victor Kamburov
- Urgent Endoscopy Unit, Emergency Hospital Pirogov, Sofia, Bulgaria
| | - Nikolai Katsarov
- Second Surgery Department, University Alexander Hospital, Sofia, Bulgaria
| | - Ivan Mitov
- Department of Medical Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria
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Boyanova L, Nikolov R, Gergova G, Evstatiev I, Lazarova E, Kamburov V, Panteleeva E, Spassova Z, Mitov I. Two-decade trends in primary Helicobacter pylori resistance to antibiotics in Bulgaria. Diagn Microbiol Infect Dis 2010; 67:319-26. [PMID: 20638598 DOI: 10.1016/j.diagmicrobio.2010.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 03/08/2010] [Accepted: 03/20/2010] [Indexed: 02/07/2023]
Abstract
Evaluating long-term trends in antibiotic resistance can predict earlier the short-term changes in resistance patterns. The aim of the present study was to compare primary resistance rates in 501 Helicobacter pylori strains in 2007 to 2009 to those in 1990 to 1995 (179 strains) and the antibiotic MICs to detect the 20-year resistance evolution. In 2007 to 2009, strains from children exhibited lower resistance rates to metronidazole (16.4%) and ciprofloxacin (2.7%) than those from adults (27.3% and 10.3%, respectively). In 2008 to 2009, more children (29.3%) harbored clarithromycin-resistant strains compared to the adults (17.4%). Overall clarithromycin resistance rate (19.4%) in 2007 to 2009 was much higher than that in 1990 to 1995 (6.2%). MIC(90) of erythromycin in 1990 to 1995 was 142.2-fold lower than that of clarithromycin in 2007 to 2009. Clarithromycin MIC(90) increased >42-fold since 2001 to 2004. Quinolone resistance rate increased 7.7-fold, being 9.2% in 2007 to 2009 versus 1.2% in 1990 to 1995, with a 5-fold increase in MIC(90). Conversely, the amoxicillin resistance decreased from 3.2% in 1996 to 1999 to 0.4% in 2007 to 2009. The MIC(90)'s of tetracycline remained stable but MIC(50)'s of both metronidazole and tetracycline before 1996 decreased about 4-fold to 2007 to 2009. In conclusion, associations between the resistance evolution and patients' age groups as well as the national outpatient antibiotic use have been found. H. pylori resistance to antibiotics showed many long-term changes, with a more rapid evolution for clarithromycin than for the other antibiotics. Metronidazole and tetracycline did not show a resistance evolution but exhibited a decrease in MIC(50) since 1990. The significant increase in ciprofloxacin resistance was found only by extending the study period to 20 years.
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Affiliation(s)
- Lyudmila Boyanova
- Medical Microbiology, Medical University of Sofia, 1431 Sofia, Bulgaria.
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Boyanova L, Ilieva J, Gergova G, Spassova Z, Nikolov R, Davidkov L, Evstatiev I, Kamburov V, Katsarov N, Mitov I. Evaluation of clinical and socio-demographic risk factors for antibacterial resistance of Helicobacter pylori in Bulgaria. J Med Microbiol 2009; 58:94-100. [PMID: 19074658 DOI: 10.1099/jmm.0.003855-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to assess the clinical and socio-demographic risk factors for primary Helicobacter pylori antibacterial resistance. In total, 266 consecutive H. pylori strains, from untreated symptomatic adult patients who answered a questionnaire, were evaluated. Strain susceptibility to amoxicillin, metronidazole, clarithromycin and tetracycline was tested by a breakpoint susceptibility test. Metronidazole resistance was found in fewer (17.0 %) peptic ulcer patients than in non-ulcer subjects (28.3 %, P=0.037), as well as in fewer patients born in villages (12.7 %) than in those born in towns (27.6 %, P=0.016). Clarithromycin resistance varied from 8.8 to 23.4 % (P=0.009) within the hospital centres. The highest clarithromycin resistance rate was found in hospital centre A (23.4 %) compared to other centres (12.9 %, P=0.041). The factors sex, age, symptom duration, non-steroidal anti-inflammatory drug use, diabetes, type of profession and educational level were not associated with H. pylori resistance. Logistic regression revealed that the risk factors for metronidazole resistance were non-ulcer disease [odds ratio (OR) 1.95, 95 % confidence interval (95 % CI) 1.04-3.65] and a birthplace of a town (OR 2.64, 95 % CI 1.18-5.93). The hospital centre may be a risk factor (OR 2.07, 95 % CI 1.02-4.21) for clarithromycin resistance but further studies are required to verify this suggestion. In conclusion, the knowledge of the risk factors for H. pylori resistance to antibacterials could facilitate the treatment choice for H. pylori eradication.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria
| | - Juliana Ilieva
- University Department of Social Medicine and Healthcare Management, Medical University of Sofia, Sofia, Bulgaria
| | - Galina Gergova
- Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria
| | - Zoya Spassova
- Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Rossen Nikolov
- Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Lubomir Davidkov
- Departments of Gastroenterology and General Surgery, University Hospital St Ekaterina, Sofia, Bulgaria
| | - Ivailo Evstatiev
- Departments of Gastroenterology and General Surgery, University Hospital St Ekaterina, Sofia, Bulgaria
| | - Victor Kamburov
- Urgent Endoscopy Unit, Emergency Hospital Pirogov, Sofia, Bulgaria
| | - Nikolai Katsarov
- Second Surgery Department, University Alexander Hospital, Sofia, Bulgaria
| | - Ivan Mitov
- Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria
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Boyanova L, Nikolov R, Lazarova E, Gergova G, Katsarov N, Kamburov V, Spassova Z, Derejian S, Jelev C, Mitov I, Krastev Z. Antibacterial resistance in Helicobacter pylori strains isolated from Bulgarian children and adult patients over 9 years. J Med Microbiol 2006; 55:65-68. [PMID: 16388032 DOI: 10.1099/jmm.0.46208-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The aim of this study was to evaluate the primary, combined and post-treatment antibacterial resistance rates in 1205 Helicobacter pylori strains from non-treated (786 adults, 282 children) and treated (109 adults, 28 children) patients in Bulgaria. Susceptibility was tested by the limited agar dilution method. Overall primary resistance rates to metronidazole, clarithromycin, amoxicillin, tetracycline and both metronidazole and clarithromycin were respectively 15·0, 12·5, 1·5, 3·4 and 4·7 % in children and 25·6, 12·6, 0·8, 5·2 and 4·9 % in adults. Primary metronidazole resistance in adults was more common than in children, but the differences for other agents tested were not significant. Primary resistance rates were in the range of those reported worldwide. There was no significant increase in primary resistance rates from 1996/1999 to 2003/2004; however, clarithromycin resistance rates exhibited a slight tendency to increase. Post-treatment resistance to amoxicillin was detected in 1·6 % of 63 strains. Post-treatment resistance to metronidazole was common (81·6 %) and that to clarithromycin was considerable (36 %). Alarming emergence of strains with triple resistance to amoxicillin, metronidazole and clarithromycin was found in two non-treated and three treated patients. The results motivate a larger and continuing surveillance of H. pylori resistance in Bulgaria and worldwide.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria
| | - Rossen Nikolov
- Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Elena Lazarova
- Department of Gastroenterology, University Paediatric Hospital, Sofia, Bulgaria
| | - Galina Gergova
- Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria
| | - Nikolai Katsarov
- Second Surgery Department of Alexander Hospital, Sofia, Bulgaria
| | - Victor Kamburov
- Urgent Endoscopy Unit, Emergency Hospital Pirogov, Sofia, Bulgaria
| | - Zoya Spassova
- Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Sirigan Derejian
- Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Christo Jelev
- Department of Gastroenterology, University Paediatric Hospital, Sofia, Bulgaria
| | - Ivan Mitov
- Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria
| | - Zacharii Krastev
- Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria
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Boyanova L, Gergova G, Spassova Z, Koumanova R, Yaneva P, Mitov I, Derejian S, Krastev Z. Campylobacter infection in 682 bulgarian patients with acute enterocolitis, inflammatory bowel disease, and other chronic intestinal diseases. Diagn Microbiol Infect Dis 2004; 49:71-4. [PMID: 15135505 DOI: 10.1016/j.diagmicrobio.2003.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of the study was to assess Campylobacter infections in 309 patients with acute enterocolitis, 272 patients with relapses of chronic enterocolitis, 70 patients with inflammatory bowel disease (involving Crohn's disease and ulcerative colitis) and 31 patients with other chronic intestinal illnesses. Isolation and identification were performed conventionally. Limited agar dilution method was used for susceptibility testing of the strains. Campylobacter species were isolated in patients with acute enterocolitis (7.8%), chronic enterocolitis (6.2%), Crohn's disease (6.2%), ulcerative colitis (3.7%), and irritable bowel syndrome (8.3%). Hippurate-positive Campylobacter jejuni isolates accounted for 62.2% of Campylobacter strains. One tetracycline resistant Campylobacter upsaliensis isolate was detected from a girl with acute enterocolitis. Resistance rates to erythromycin (31.1%) and clarithromycin (22.2%) were high, whereas those to amoxicillin/clavulanate (4.4%), ampicillin/sulbactam (13.3%), tetracycline (24.4%) and ciprofloxacin (22.2%) were relatively low. Resistance to erythromycin and either tetracycline or ciprofloxacin was detected in 8.9% and 6.7%. The involvement of Campylobacter infection in relapses of chronic intestinal disorders and the susceptibility patterns of the strains strongly emphasize the role of Campylobacter as a cause of infection in this group of patients.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Microbiology, Medical University of Sofia, Sofia, Bulgaria.
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Boyanova L, Katsarov N, Gergova G, Nikolov R, Derejian S, Spassova Z, Mitov I, Krastev Z. Helicobacter pylori infection in elderly Bulgarian patients. J Med Microbiol 2003; 52:1131-1133. [PMID: 14614074 DOI: 10.1099/0022-1317-52-12-1131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Lyudmila Boyanova
- Department of Microbiology, Medical University of Sofia, Sofia, Bulgaria 2Second Surgery Department of Alexander Hospital, Sofia, Bulgaria 3Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia, Bulgaria
| | - Nikolai Katsarov
- Department of Microbiology, Medical University of Sofia, Sofia, Bulgaria 2Second Surgery Department of Alexander Hospital, Sofia, Bulgaria 3Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia, Bulgaria
| | - Galia Gergova
- Department of Microbiology, Medical University of Sofia, Sofia, Bulgaria 2Second Surgery Department of Alexander Hospital, Sofia, Bulgaria 3Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia, Bulgaria
| | - Rossen Nikolov
- Department of Microbiology, Medical University of Sofia, Sofia, Bulgaria 2Second Surgery Department of Alexander Hospital, Sofia, Bulgaria 3Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia, Bulgaria
| | - Sirigan Derejian
- Department of Microbiology, Medical University of Sofia, Sofia, Bulgaria 2Second Surgery Department of Alexander Hospital, Sofia, Bulgaria 3Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia, Bulgaria
| | - Zoya Spassova
- Department of Microbiology, Medical University of Sofia, Sofia, Bulgaria 2Second Surgery Department of Alexander Hospital, Sofia, Bulgaria 3Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia, Bulgaria
| | - Ivan Mitov
- Department of Microbiology, Medical University of Sofia, Sofia, Bulgaria 2Second Surgery Department of Alexander Hospital, Sofia, Bulgaria 3Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia, Bulgaria
| | - Zacharii Krastev
- Department of Microbiology, Medical University of Sofia, Sofia, Bulgaria 2Second Surgery Department of Alexander Hospital, Sofia, Bulgaria 3Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia, Bulgaria
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Boyanova L, Stancheva I, Spassova Z, Katzarov N, Mitov I, Koumanova R. Primary and combined resistance to four antimicrobial agents in Helicobacter pylori in Sofia, Bulgaria. J Med Microbiol 2000; 49:415-418. [PMID: 10798553 DOI: 10.1099/0022-1317-49-5-415] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to evaluate the primary and combined resistance of Helicobacter pylori against four antimicrobial agents by a screening agar method (SAM) and a modified disk diffusion method (MDDM) alone and in combination. Pre-treatment H. pylori isolates from 192 consecutive H. pylori-positive patients at three hospitals in Sofia were investigated. MDDM was performed with disks containing metronidazole (5 microg), clarithromycin (15 microg) or erythromycin (15 microg), ciprofloxacin (5 microg) and tetracycline (30 microg). Resistance was determined by an inhibitory zone of <16 mm for metronidazole and < or =30 mm for other agents tested. The cut-off concentrations used to define resistance by SAM were: metronidazole >8 mg/L, clarithromycin >2 mg/L, tetracycline >4 mg/L and ciprofloxacin >1 mg/L. Primary resistance rates in H. pylori were: metronidazole 28.6%, clarithromycin 9.7%, metronidazole + clarithromycin 2.8%, ciprofloxacin 3.9%, metronidazole + ciprofloxacin 2.3%, tetracycline 1.9% and metronidazole + tetracycline 1.2%. Among metronidazole-resistant isolates, combined resistance to clarithromycin, ciprofloxacin and tetracycline was present in 11.4% (5 of 44 strains), 8.3% (3 of 36) and 4.9% (2 of 41), respectively. Two strains exhibited triple resistance to macrolides, metronidazole and either ciprofloxacin or tetracycline. Three tetracycline-resistant strains were detected in 1999; however, resistance rates to other agents were relatively stable during the 6 years. Primary H. pylori resistance to metronidazole is moderate and resistance to clarithromycin and to ciprofloxacin is considerable in comparison with results in most other countries. The alarming appearance of strains harbouring combined resistance or multiresistance provides the motivation for continued surveillance of H. pylori at global, national and regional levels.
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Affiliation(s)
| | - Irina Stancheva
- Department of Microbiology, Medical University, Sofia, *Department of Gastroenterology, Hospital of the Ministry of Internal Affairs, Sofia, †Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia and ‡Department of Gastroenterology, University Paediatric Hospital, Sofia, Bulgaria
| | - Zoya Spassova
- Department of Microbiology, Medical University, Sofia, *Department of Gastroenterology, Hospital of the Ministry of Internal Affairs, Sofia, †Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia and ‡Department of Gastroenterology, University Paediatric Hospital, Sofia, Bulgaria
| | - Nikolai Katzarov
- Department of Microbiology, Medical University, Sofia, *Department of Gastroenterology, Hospital of the Ministry of Internal Affairs, Sofia, †Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia and ‡Department of Gastroenterology, University Paediatric Hospital, Sofia, Bulgaria
| | | | - Radka Koumanova
- Department of Microbiology, Medical University, Sofia, *Department of Gastroenterology, Hospital of the Ministry of Internal Affairs, Sofia, †Department of Gastroenterology, University Hospital 'St Ivan Rilski', Sofia and ‡Department of Gastroenterology, University Paediatric Hospital, Sofia, Bulgaria
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Boyanova L, Spassova Z, Krastev Z, Petrov S, Stancheva I, Docheva J, Mitov I, Koumanova R. Characteristics and trends in macrolide resistance among Helicobacter pylori strains isolated in Bulgaria over four years. Diagn Microbiol Infect Dis 1999; 34:309-13. [PMID: 10459482 DOI: 10.1016/s0732-8893(99)00038-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Macrolide resistance trends were examined among Helicobacter pylori strains from 154 patients between 1994 and 1998. Applicabilities of screening agar method (SAM) and modified disk diffusion method (MDDM) were evaluated. Overall primary resistance rates to erythromycin and clarithromycin were 14.8% and 8.7%, respectively. No association was found with age, sex, and diseases. Clarithromycin-resistance rate reached 12.5% in the last 2 years. Secondary resistance to erythromycin occurred more often (in 62.5%) than to clarithromycin (in 42.9%). Therapy with spiramycin or erythromycin in four cases induced no clarithromycin resistance. These data show a considerable prevalence of H. pylori resistance to macrolides, which exhibited a tendency to increase and was often associated with metronidazole resistance. By comparing the MDDM with SAM, an overall agreement was obtained in 81 (94.2%) of 86 results. MDDM and SAM are reliable techniques for testing H. pylori susceptibility to macrolides.
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Affiliation(s)
- L Boyanova
- Department of Microbiology, Medical University, Sofia, Bulgaria
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