Antibiotic resistance among <em>Helicobacter pylori</em> clinical isolates in Lima, Peru

Abstract

ObjectivesGastric carcinoma is the most common cancer and cause of cancer mortality in Peru. Helicobacter pylori, a bacterium that colonizes the human stomach, is a Group 1 carcinogen due to its causal relationship to gastric carcinoma. While eradication of H. pylori can help prevent gastric cancer, characterizing regional antibiotic resistance patterns is necessary to determine targeted treatment for each region. Thus, we examined primary antibiotic resistance in clinical isolates of H. pylori in Lima, Peru.Materials and methodsH. pylori strains were isolated from gastric biopsies of patients with histologically proven H. pylori infection. Primary antibiotic resistance among isolates was examined using E-test strips. Isolates were examined for the presence of the cagA pathogenicity island and the vacA m1/m2 alleles via polymerase chain reaction.ResultsSeventy-six isolates were recovered from gastric biopsies. Clinical isolates showed evidence of antibiotic resistance to 1 (27.6%, n=21/76), 2 (28.9%, n=22/76), or ≥3 antibiotics (40.8%). Of 76 isolates, eight (10.5%) were resistant to amoxicillin and clarithromycin, which are part of the standard triple therapy for H. pylori infection. No trends were seen between the presence of cagA, vacA m1, or vacA m2 and antibiotic resistance.ConclusionThe rate of antibiotic resistance among H. pylori isolates in Lima, Peru, is higher than expected and presents cause for concern. To develop more targeted eradication therapies for H. pylori in Peru, more research is needed to better characterize antibiotic resistance among a larger number of clinical isolates prospectively.

Cancer-related mortality in Peru: Trends from 2003 to 2016

“…In Peru, it represents the leading cancer cause of death in adults, and is possibly explained by Helicobacter pylori infections, dietary and lifestyle factors, and genetic factors [32]. There are reasons to believe that the trend of deaths from gastric cancer could be increasing in Peru because of waterborne transmission of H. pylori [32] due to poor hygiene, and antibiotic resistance to standard therapy for this bacteria [33][34][35]. Despite this, according to our analysis, the proportion of deaths due to gastric cancer has declined between 2003 and 2016.…”

Susceptibilidad antimicrobiana y mutaciones en el gen ARNr 23s de Helicobacter pylori en pacientes dispépticos

“…La evaluación de la susceptibilidad antimicrobiana mostró un aumento en las tasas de resistencia a claritromicina (52,3%) y levofloxacino (45,5%), respecto a lo reportado en 1983 y 2013 para claritromicina (6,7% y 35,5%, respectivamente) y lo reportado en 2011 para levofloxacino (36.9%), en Perú (12,15,16) . Según Megraud et al este aumento de las tasas de resistencia podría estar influenciado por el incremento del consumo de estos fármacos en los últimos años, llegando al 70% respecto a otros antimicrobianos (17) .…”

Current understanding and management of Helicobacter pylori infection: an updated appraisal

“…In Nigeria, metronidazole resistance was reported to be up to 99% 69 . On the other hand, in South Africa 71 , Peru 72 , Algeria 73 , Canada 74 , and Morocco 75 and in other European countries such as Poland 76 and France 77 , together with other Asia-Pacific regions (for example, India, Iran, Saudi Arabia, South Korea, China, and Vietnam) 55 , higher resistance rates than the threshold levels for both clarithromycin and metronidazole have been reported ( Figure 1 , area III). In most regions, the frequent use of antibiotics is the main contributor to drug resistance and the declining efficacy of eradication therapies.…”