Helicobacter pylori antibiotic susceptibility patterns in Bangladesh: Emerging levofloxacin resistance

Introduction: The most recent study to report Helicobacter pylori antibiotic resistance rates in Bangladesh was published 15 years ago and did not include levofloxacin. We therefore aimed to determine the current antibiotic susceptibility of H. pylori to amoxicillin, clarithromycin, metronidazole, tetracycline and levofloxacin in Bangladesh. Methodology: This study included 133 consecutive patients who underwent endoscopy examination at Dhaka Medical College in November 2014. The serial two-fold agar dilution method was used to determine the minimum inhibitory concentrations of the five antibiotics. Results: Among 56 cultured strains, H. pylori showed high rates of resistance to clarithromycin and metronidazole (39.3% and 94.6%, respectively). Moreover, levofloxacin showed an emerging antimicrobial resistance pattern (66.1%), which was higher in patients with gastritis than that in those with peptic ulcers (p = 0.02). The resistance rate of levofloxacin was significantly higher in patients living in Dhaka city compared to those living in the village (p = 0.049). However, amoxicillin and tetracycline resistance rates were very low. Resistance to both metronidazole and levofloxacin was most commonly observed. Conclusions: The rates of resistance to clarithromycin, metronidazole, and levofloxacin were high in Bangladesh, which suggests that triple therapy based on these drugs may not be useful as first-line therapies in Bangladesh. Alternative strategies such as furazolidone-based triple therapy, bismuth-based quadruple therapies, or sequential therapy may be more effective for patients in in Bangladesh.

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Helicobacter pylori antibiotic resistance in Brazil: clarithromycin is still a good option

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032011000400008 ◽

2011 ◽

Vol 48 (4) ◽

pp. 261-264 ◽

Cited By ~ 29

Author(s):

Jaime Natan Eisig ◽

Fernando Marcuz Silva ◽

Ricardo Correa Barbuti ◽

Tomás Navarro-Rodriguez ◽

Joaquim Prado P Moraes-Filho ◽

...

Keyword(s):

Helicobacter Pylori ◽

Antibiotic Susceptibility ◽

Dilution Method ◽

Agar Dilution Method ◽

Upper Gastrointestinal Endoscopy ◽

Test Results ◽

Primary Resistance ◽

Agar Dilution ◽

H Pylori

CONTEXT: The antibiotic susceptibility is the cornerstone for the eradication therapies of Helicobacter pylori. OBJECTIVES: To evaluate the prevalence of primary resistance of H. pylori was evaluated in an urban Brazilian population. METHODS:H. pylori isolates were obtained from patients submitted to an upper gastrointestinal endoscopy for the evaluation of dyspeptic symptoms. Biopsies from antrum, corpus and fundus were taken to determine the antibiotic susceptibility of H. pylori isolates. The minimal inhibitory concentration of furazolidone and bismuth were routinely determined by agar dilution method and the minimal inhibitory for amoxicillin, clarithromycin, tetracycline, levofloxacin, and metronidazole were routinely determined with the E-test. RESULTS: Fifty-four patients were included. In vitro antimicrobial susceptibility of H. pylori strains were obtained from 39 patients. Resistance to metronidazole was detected in 20 patients (51%), to clarithromycin in 3 patients (8%), to levofloxacin in 9 patients (23%) and to bismuth in 2 patients (5%). There was no observed resistance to amoxicillin, tetracycline or furazolidone. CONCLUSION: Due to the low amoxicillin and clarithromycin resistance observed in this study, therapies using these antimicrobials remain appropriated first-line H. pylori therapy.

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Antibacterial resistance in Helicobacter pylori strains isolated from Bulgarian children and adult patients over 9 years

Journal of Medical Microbiology ◽

10.1099/jmm.0.46208-0 ◽

2006 ◽

Vol 55 (1) ◽

pp. 65-68 ◽

Cited By ~ 21

Author(s):

Lyudmila Boyanova ◽

Rossen Nikolov ◽

Elena Lazarova ◽

Galina Gergova ◽

Nikolai Katsarov ◽

...

Keyword(s):

Helicobacter Pylori ◽

Treatment Resistance ◽

Post Treatment ◽

Dilution Method ◽

Agar Dilution Method ◽

Antibacterial Resistance ◽

Primary Resistance ◽

Metronidazole Resistance ◽

H Pylori ◽

Resistance Rates

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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Potential of FTIR-Spectroscopy for Drugs Screening against Helicobacter pylori

Antibiotics ◽

10.3390/antibiotics9120897 ◽

2020 ◽

Vol 9 (12) ◽

pp. 897

Author(s):

Pedro Sousa Sampaio ◽

Cecília R. C. Calado

Keyword(s):

Helicobacter Pylori ◽

Ftir Spectroscopy ◽

Partial Least Square ◽

Least Square ◽

New Drugs ◽

Partial Least Square Regression ◽

Dilution Method ◽

Agar Dilution Method ◽

Molecular Fingerprint ◽

H Pylori

Helicobacter pylori colonizes the human stomach of half of the world’s population. The infection if not treated, persists through life, leading to chronic gastric inflammation, that may progress to severe diseases as peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. The first line of treatment, based on 7 to 21 days of two antibiotics associated with a proton pump inhibitor, is, however, already failing most due to patient non-compliance that leads to antibiotic resistance. It is, therefore, urgent to screen for new and more efficient antimicrobials against this bacterium. In this work, Fourier Transform Infrared (FTIR) spectroscopy was evaluated to screen new drugs against H. pylori, in rapid (between 1 to 6 h), and high-throughput mode and based on a microliter volume processes in relation to the agar dilution method. The reference H. pylori strains 26,695 and J99, were evaluated against a peptide-based antimicrobial and the clinical antibiotic clarithromycin, respectively. After optimization of the assay conditions, as the composition of the incubation mixture, the time of incubation, and spectral pre-processing, it was possible to reproducibly observe the effect of the drug on the bacterial molecular fingerprint as pointed by the spectra principal component analysis. The spectra, obtained from both reference strains, after its incubation with drugs concentrations lower than the MIC, presented peak ratios statistically different (p < 0.05) in relation to the bacteria incubated with drugs concentrations equal or higher to the MIC. It was possible to develop a partial least square regression model, enabling to predict from spectra of both bacteria strains, the drug concentration on the assay, with a high correlation coefficient between predicted and experimental data (0.91) and root square error of 40% of the minimum inhibitory concentration. All this points to the high potential of the technique for drug screening against this fastidious growth bacterium.

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Antimicrobial Sensitivity Pattern of Helicobacter pylori Isolates among Subgroup of Bangladeshi Patients

Faridpur Medical College Journal ◽

10.3329/fmcj.v8i2.20280 ◽

2014 ◽

Vol 8 (2) ◽

pp. 49-52

Author(s):

MMSU Islam ◽

Shamsun Nahar ◽

Mst Naznin Sarker ◽

ASM Salimullah ◽

Mohammad Asadur Rahman ◽

...

Keyword(s):

Helicobacter Pylori ◽

Diarrhoeal Disease ◽

Cross Sectional Study ◽

Dilution Method ◽

Agar Dilution Method ◽

Cross Sectional ◽

Antimicrobial Sensitivity ◽

Sensitivity Pattern ◽

H Pylori ◽

Medical University

This cross sectional study was carried out at Bangabandhu Sheikh Mujib Medical University (BSMMU) and International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from July 2008 to September 2009. Aim of the study was to find out the antimicrobial susceptibility profile of Helicobacter pylori isolates from dyspeptic patients. Total 224 dyspeptic patients from Out Patient Department (OPD) of BSMMU were initially enrolled after informed written consent. After upper GI endoscopy 157 patients were finally included who had erosions, ulcers or atrophic changes in the stomach or duodenum. Two biopsy samples were taken from each of them. Samples were incubated at 37°C in a double gas incubator with 5%O2, 10%CO2 and 85%N2. Total 82 (52.23%) samples were found positive for H. pylori. Isolated organisms were then tested for sensitivity to Amoxicillin, Clarithromycin, Tetracycline, Levofloxacin and Metronidazole by Agar dilution method. Among 82 patients 51(62.2%) were male and 31(37.8) were female with a male:female ratio 1.6:1. Patients were categorized into two groups one having gastric or duodenal ulcer (30.5%) and other having no ulcer (69.5%). Among these isolates 92.7% were sensitive to Amoxicillin, 89% to Clarithromycin, 81.7% to Tetracycline, 80.5% to Levofloxacin and only 26.8% to Metronidazole. Beside these, 81.7% isolates were sensitive to both Amoxicillin and Clarithromycin, 74.4% to Amoxicillin and Tetracycline, 73.2% to Amoxicillin and Levofloxacin, 72% to Clarithromycin and Tetracycline, 59% to Clarithromycin and Levofloxacin and 51% to Tetracycline and Levofloxacin DOI: http://dx.doi.org/10.3329/fmcj.v8i2.20280 Faridpur Med. Coll. J. 2013;8(2): 49-52

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Antibiotic Resistance of Helicobacter Pylori and Influencing Factors in Yangzhou, China: a Cross-sectional Study

10.21203/rs.3.rs-198405/v1 ◽

2021 ◽

Author(s):

Yun Zhang ◽

Xinyi Feng ◽

Lijun Bian ◽

Yan Zhang ◽

Qian Li ◽

...

Keyword(s):

Helicobacter Pylori ◽

Antibiotic Resistance ◽

Gastrointestinal Symptoms ◽

Cross Sectional Study ◽

Resistance Rate ◽

Resistance Pattern ◽

Cross Sectional ◽

Chip Technology ◽

Resistance Patterns ◽

H Pylori

Abstract Background: The Helicobacter pylori (H. pylori) antibiotic resistance pattern differs geographically, knowledge of local antimicrobial resistance pattern is key to successful eradication. The current study was performed to investigate the resistance of H. pylori to 5 commonly used antibiotics in Yangzhou.Methods: A total of 461 H. pylori strains were collected from April 2018 to September 2019 in Yangzhou and tested for their susceptibility to clarithromycin, levofloxacin, metronidazole, amoxicillin, tetracycline using gene chip technology.Results: The resistance rates of H. pylori to clarithromycin, levofloxacin, metronidazole, amoxicillin and tetracycline were 41.0%, 44.9%, 38.8%, 6.3% and 1.1%. In addition, sixteen multiple resistance patterns were detected, and fortunately there were no strains resistant to all five antibiotics. The vacA s1 allele was detected in each strain, 64.0% of the isolates were s1/m2 genotype, 36.0% s1/m1 genotype. In multivariate analysis, history of chronic superficial gastritis was significantly associated with clarithromycin resistance, strains isolated from subjects with gastrointestinal symptoms had a significantly higher likelihood of metronidazole resistance, and antibiotic resistance of H. pylori was independent of both sex and age.Conclusion: The resistance rate of H. pylori to clarithromycin, levofloxacin and metronidazole were very high in Yangzhou, the results will help in selecting effective eradication regimens.

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COLISTIN RESISTANCE IN CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE STRAINS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i9.18369 ◽

2017 ◽

Vol 10 (9) ◽

pp. 70

Author(s):

Beena Hosdurg Bhaskar ◽

Shalini Shenoy Mulki ◽

Sangeeta Joshi ◽

Ranjeeta Adhikari ◽

Bhavana Malavalli Venkatesh

Keyword(s):

Antibiotic Susceptibility ◽

Antimicrobial Agents ◽

Susceptibility Testing ◽

Ethylenediaminetetraacetic Acid ◽

Diffusion Method ◽

Resistance Pattern ◽

Dilution Method ◽

Agar Dilution Method ◽

Antibiotic Susceptibility Testing ◽

Carbapenem Resistant

Objective: There is an increasing use of colistin consequent to increase in the infections caused by carbapenem-resistant Klebsiella pneumoniae.The present study was conducted to determine the minimum inhibitory concentration (MIC) of colistin and the resistance pattern of colistin in carbapenem-resistant K. pneumoniae (CRKP) strains in our intensive care unit (ICU).Methods: Antibiotic susceptibility testing for other antimicrobial agents was done by Kirby-Bauer disk diffusion method. MIC of colistin was determined by agar dilution method. The results of antibiotic susceptibility testing were interpreted as per Clinical Laboratory Standard Institute guidelines 2016 and MIC of colistin were interpreted as per European Committee on Antimicrobial susceptibility testing. The carbapenem resistance was phenotypically detected by modified hodge test and imipenem/imipenem ethylenediaminetetraacetic acid disk method.Results: Out of 518 K. pneumoniae, 329 were resistant to carbapenems, and 91 isolates showed resistance to colistin. The MIC of colistin ranged between 4 and >512 ug/ml and MIC90 was 16 ug/L and MIC50 was 4 ug/ml. A majority of the colistin-resistant isolates were found in multidisciplinary ICU (85/91).Conclusion: The emergence of colistin-resistant strains is a major problem due to limited treatment options for infections caused by CRKP carbapenemase producing K. pneumoniae. Colistin should not be used alone, combination therapy should be preferred.

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High Prevalence of Antibiotic Resistance in Iranian Helicobacter pylori Isolates: Importance of Functional and Mutational Analysis of Resistance Genes and Virulence Genotyping

Journal of Clinical Medicine ◽

10.3390/jcm8112004 ◽

2019 ◽

Vol 8 (11) ◽

pp. 2004 ◽

Cited By ~ 8

Author(s):

Nastaran Farzi ◽

Abbas Yadegar ◽

Amir Sadeghi ◽

Hamid Asadzadeh Aghdaei ◽

Sinéad Marian Smith ◽

...

Keyword(s):

Helicobacter Pylori ◽

Antibiotic Resistance ◽

Rrna Genes ◽

23S Rrna ◽

Dilution Method ◽

Agar Dilution Method ◽

Gyra Gene ◽

Therapeutic Regime ◽

High Prevalence ◽

H Pylori

The high prevalence of antibiotic resistance in Helicobacter pylori has become a great challenge in Iran. The genetic mutations that contribute to the resistance have yet to be precisely identified. This study aimed to investigate the prevalence of antibiotic resistance and virulence markers in Iranian H. pylori isolates and to analyze if there is any association between resistance and genotype. Antibiotic susceptibility patterns of 68 H. pylori isolates were investigated against metronidazole, clarithromycin, amoxicillin, rifampicin, ciprofloxacin, levofloxacin, and tetracycline by the agar dilution method. The frxA, rdxA, gyrA, gyrB, and 23S rRNA genes of the isolates were sequenced. The virulence genotypes were also determined using PCR. Metronidazole resistance was present in 82.4% of the isolates, followed by clarithromycin (33.8%), ciprofloxacin (33.8%), rifampicin (32.4%), amoxicillin (30.9%), levofloxacin (27.9%), and tetracycline (4.4%). Overall, 75% of the isolates were resistant to at least two antibiotics tested and considered as a multidrug resistance (MDR) phenotype. Most of the metronidazole-resistant isolates carried frameshift mutations in both frxA and rdxA genes, and premature termination occurred in positions Q5Stop and Q50Stop, respectively. Amino acid substitutions M191I, G208E, and V199A were predominantly found in gyrA gene of fluoroquinolone-resistant isolates. A2143G and C2195T mutations of 23S rRNA were found in four clarithromycin-resistant isolates. Interestingly, significant associations were found between resistance to metronidazole (MNZ) and cagA-, sabA-, and dupA-positive genotypes, with p = 0.0002, p = 0.0001, and p = 0.0001, respectively. Furthermore, a significant association was found between oipA “on” status and resistance to amoxicillin (AMX) (p = 0.02). The prevalence of H. pylori antibiotic resistance is high in our region, particularly that of metronidazole, clarithromycin, ciprofloxacin, and MDR. Simultaneous screening of virulence and resistance genotypes can help clinicians to choose the appropriate therapeutic regime against H. pylori infection.

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Activity of Bulgarian propolis against 94 Helicobacter pylori strains in vitro by agar-well diffusion, agar dilution and disc diffusion methods

Journal of Medical Microbiology ◽

10.1099/jmm.0.45880-0 ◽

2005 ◽

Vol 54 (5) ◽

pp. 481-483 ◽

Cited By ~ 83

Author(s):

Lyudmila Boyanova ◽

Galina Gergova ◽

Rossen Nikolov ◽

Sirigan Derejian ◽

Elena Lazarova ◽

...

Keyword(s):

Helicobacter Pylori ◽

Growth Inhibition ◽

Biological Effects ◽

Diffusion Method ◽

Dilution Method ◽

Agar Dilution Method ◽

Propolis Extract ◽

Agar Dilution ◽

H Pylori

Propolis exhibits antimicrobial, anti-inflammatory and other biological effects. The aim of this study was to evaluate the activity of 30 % ethanolic extract of Bulgarian propolis against 94 Helicobacter pylori strains by three methods. By the agar-well diffusion method, only 13.8 % of the strains exhibited no inhibition by 30 μl propolis extract (containing 9 mg propolis) and all isolates were inhibited to some extent by 90 μl of the extract (27 mg propolis) per well. The mean diameters of growth inhibition by 30, 60 or 90 μl propolis extract or 30 μl 96 % ethanol per well were 16.8, 19.2, 27.5 and 8.3 mm, respectively. The propolis extract was more active than the ethanol (P < 0.001). With 90 μl propolis extract per well, 69.4 % of the strains exhibited large diameters of growth inhibition (⩾20 mm) versus 26.6 % with 30 μl per well (P < 0.001). With moist propolis discs, inhibition was detected in more strains (92.1 %) than with dried discs (78.2 %, P < 0.05), with mean inhibitory diameters of 18.7 and 13.8 mm, respectively. By the agar dilution method, 100 and 300 μg propolis ml−1 inhibited the growth of 57.1 % and 76.2 %, respectively, of the 21 strains tested. In conclusion, Bulgarian propolis had a strong and dose-dependent activity against most of the H. pylori strains tested. Although the effect of propolis on H. pylori in vitro is promising, further microbiological, pharmacological and clinical trials are required.

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Antimicrobial resistance of Helicobacter pylori in Smolensk

Clinical Microbiology and Antimicrobial Chemotherapy ◽

10.36488/cmac.2018.1.42-48 ◽

2018 ◽

Vol 20 (1) ◽

pp. 42-48

Author(s):

Natalya N. Dekhnich ◽

Nataly V. Ivanchik ◽

Roman S. Kozlov ◽

A.V. Alimov ◽

A.S. Steshits ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Triple Therapy ◽

Empirical Therapy ◽

Adult Patients ◽

Dilution Method ◽

Agar Dilution Method ◽

Rapid Urease Test ◽

Quadruple Therapy ◽

Urease Test ◽

H Pylori

Objective. To study the antimicrobial resistance of H. pylori to clarithromycin, amoxicillin, metronidazole, levofloxacin, tetracycline in adult patients in the Smolensk region. Materials and Methods. Overall, 573 adult patients were included in 2015-2017 and 210 – in 20092010 with positive rapid urease test at the time of gastroscopy for dyspeptic complaints. Antimicrobial susceptibility testing of H. pylori isolates to clarithromycin, amoxicillin, metronidazole, levofloxacin and tetracycline was performed by the agar dilution method. Results. 143 and 133 strains of H. pylori isolated in 2015-2017 and in 2009-2010 were tested. The rates of resistance of H. pylori strains in 2015-2017 were 6.3% for clarithromycin, 1.4% – for amoxicillin, 23.8% – for metronidazole, 24.5% – for levofloxacin, 0.7% – for tetracycline. In 2009-2010 the corresponding numbers were: 5.3% – for clarithromycin, 4.5% – for amoxicillin, 3.8% – for metronidazole, 8.3% – for levofloxacin, 0% – for tetracycline. When assessing the dynamics of antimicrobial resistance of H. pylori in the Smolensk region over the past 9 years, there has been no noticeable increase in the resistance to clarithromycin, amoxicillin and tetracycline (p>0.05), with a significant increase in H. pylori resistance to metronidazole and levofloxacin (p<0,01). The resistance of H. pylori to metronidazole did not exceed the critical value of 40%. Conclusions. The prevalence of H. pylori resistance to clarithromycin and metronidazole in the Smolensk region was low throughout the study period, therefore standard triple therapy is recommended as a first line empirical therapy for H. pylori infection in adults. Preference in choosing a second-line empirical therapy between quadruple therapy with bismuth and triple therapy with levofloxacin should be stated in favor of quadruple therapy with bismuth because of the high rates of H. pylori resistance to levofloxacin.

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The Prevalence of Multidrug Resistance of Helicobacter pylori and Its Impact on Eradication in Korea from 2017 to 2019: A Single-Center Study

Antibiotics ◽

10.3390/antibiotics9100646 ◽

2020 ◽

Vol 9 (10) ◽

pp. 646

Author(s):

Jae Yong Park ◽

Tae-Seop Shin ◽

Ji Hyun Kim ◽

Hong Jip Yoon ◽

Beom Jin Kim ◽

...

Keyword(s):

Helicobacter Pylori ◽

Multidrug Resistance ◽

Eradication Therapy ◽

University Hospital ◽

Gastric Body ◽

Dilution Method ◽

Agar Dilution Method ◽

Line Treatment ◽

First Line ◽

H Pylori

Antimicrobial resistance is one of the major factors determining the efficacy of Helicobacter pylori eradication therapy. This study aimed to estimate the recent prevalence of multidrug resistance of H. pylori and its impact on eradication in Korea. A total of 174 patients were prospectively enrolled at Chung-Ang University Hospital from 2017 to 2019. H. pylori strains were isolated from the gastric body and antrum. The minimum inhibitory concentrations of antibiotics were determined by the serial twofold agar dilution method. Eradication results were reviewed and analyzed in connection with antibiotic resistance. The prevalence of H. pylori infection was 51.7% (90/174). The culture success rate was 77.8% (70/90). The resistance rates for clarithromycin, metronidazole, amoxicillin, tetracycline, levofloxacin, and moxifloxacin were 28.6% (20/70), 27.1% (19/70), 20.0% (14/70), 18.6% (13/70), 42.9% (30/70), and 42.9% (30/70), respectively. The multidrug resistance (resistance to two or more classes of antimicrobials) rate was 42.9% (30/70). Dual resistance to clarithromycin and metronidazole was confirmed in 8.6% (6/70). Eradication with a first-line treatment was successful in 75% (36/48), and those who received second-line treatment all achieved successful eradication. The rate of multidrug resistance is increasing, and standard triple therapy (STT) is no longer an acceptable first-line option for H. pylori eradication in Korea.

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