Antibiotic Resistance in Helicobacter pylori: A Mutational Analysis from a Tertiary Care Hospital in Kashmir, India

Wani, Fayaz Ahmad; Bashir, Gulnaz; Khan, Mushtaq Ahmad; Zargar, Showkat Ali; Rasool, Zubaida; Qadri, Qurteeba

doi:10.4103/ijmm.ijmm_18_19

Cited by 27 publications

(29 citation statements)

References 34 publications

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“…To our knowledge, this is the first study to examine the prevalence of antimicrobial resistance of H. pylori in Karnataka state of South India. In India, the prevalence of metronidazole-resistant H. pylori is remarkably high, with resistance rates reaching at least 80% in several areas [16–18, 20, 21]. Importantly, such high occurrence of metronidazole resistance was also observed in our isolated clinical strains, indicating that conventional triple therapy consisting of metronidazole should not be used to treat H. pylori infection in Karnataka.…”

Section: Discussionmentioning

confidence: 75%

High primary resistance to metronidazole and levofloxacin, and a moderate resistance to clarithromycin in Helicobacter pylori isolated from Karnataka patients

et al. 2019

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Background Due to increased prevalence of H. pylori antimicrobial resistance worldwide and more importantly the resistance patterns vary between different geographical regions, it is important to survey local H. pylori antibiotic resistance profile to provide physicians with more informed drug choices to better treat H. pylori infection. To our knowledge, this is the first study to examine the prevalence of antimicrobial resistance of H. pylori in Karnataka state of South India. Results A total of 113 H. pylori strains were isolated from gastric biopsies and tested: 81.4% were resistant to metronidazole, 54.9% were resistant to levofloxacin, 20.4% were resistant to clarithromycin, 5.3% were resistant to tetracycline and 7.1% were resistant to amoxicillin. Multidrug resistance was detected in 59.3% of total isolated strains, among which 86.6% were resistant to at least both metronidazole and levofloxacin. In this study, 38 out of 113 H. pylori strains had been whole-genome sequenced. Based on the draft genomes, RdxA and/or FrxA inactivation mutations were found to present in 75% of metronidazole-resistant strains. Clarithromycin-resistant strains had mainly A2143G and G2224A mutations in the 23 rRNA gene. While 87.1% levofloxacin-resistant strains had amino acid substitution mutations occurring predominantly at N87 and D91 in GyrA, novel mutations in the same protein including an insertion of five amino acid residues (QDNSV), immediately after the start codon, and a substitution mutation at R295 were identified. Conclusion High primary resistance to metronidazole and levofloxacin, and a modest occurrence of clarithromycin resistance were revealed in H. pylori strains isolated from Karnataka patients. Therefore metronidazole-, levofloxacin- and clarithromycin-based triple therapies are not suitable as first-line treatment in Karnataka. Both amoxicillin and tetracycline can still be used to eradicate H. pylori infection in this region. We also revealed novel mutations in GyrA protein that possibly contribute to H. pylori resistance in levofloxacin, which merit further investigations. Electronic supplementary material The online version of this article (10.1186/s13099-019-0305-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 75%

High primary resistance to metronidazole and levofloxacin, and a moderate resistance to clarithromycin in Helicobacter pylori isolated from Karnataka patients

et al. 2019

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“…29 All the ureC positive cases were either RUT or histological staining positive. 42,43 Prevalence of the particular point mutations varies across geographical areas. On the contrary, Gehlot et al (2016) and Nakamura et al (2007) reported 87.5% and 99.0% point mutation at A2143G position.…”

Section: Resultsmentioning

confidence: 99%

Mutational Analysis of Clarithromycin and Levofloxacin Resistance in Helicobacter pylori from Gastric Biopsy Specimens in a Tertiary Care Hospital in Dhaka, Bangladesh

Tanni

Anwar

Ahmed

et al. 2019

Bangladesh J Med Microbiol

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Background: Clarithromycin and Levofloxacin are most frequently included in the standard triple therapies for H. pylori eradication in our country. Resistance to clarithromycin and fluoroquinolones are particularly related with treatment failure. Objectives: The objective of this study was to detect, clarithromycin and levofloxacin resistance associated with gene mutations in H. pylori directly from gastric biopsies using an allele specific primer-PCR (ASP-PCR) assay. Materials and Methods: Gastric biopsy specimens were collected from 143 adult dyspeptic patients, from Department of Gastroenterology, BSMMU and Dhaka Medical College Hospital (DMCH), during the period of March, 2018 to February, 2019. H. pylori was identified by rapid urease test, ureC gene by PCR, histological staining and culture. ASP-PCR was used to identify 23S rRNA gene and gyrA gene mutation predictive of clarithromycin and levofloxacin resistant H. pylori respectively. Results: H. pylori positive cases were 32.9% based on the case definition used in the study. Among 42 ureC positive H. pylori cases, point mutations in 23Sr RNA gene for clarithromycin resistance were detected only at A2142G position in 9 (21.4%) cases and gyrA gene mutations for levofloxacin resistance were detected in 16 (38.1%) cases. Only 1 (2.4%) case had mutation both in 23Sr RNA and gyrA gene. Conclusion: Those findings may guide toward the therapeutic choices in our country. PCR based diagnostic assays can be the alternative approach for rapid detection of antibiotic resistances of H. pylori directly from gastric biopsies, where culture and susceptibility tests are not routinely performed. Bangladesh J Med Microbiol 2019; 13 (1): 12-19

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“…Since macrolide antibiotics show cross resistance, the higher clarithromycin resistance rates could be attributed to indiscriminate use of erythromycin and azithromycin in our population for respiratory infections [ 33 ]. Antibiotic resistance is an important conditioning factor for the success of H. pylori treatment.…”

Section: Main Textmentioning

confidence: 99%

Highly clarithromycin-resistant Helicobacter pylori infection in asymptomatic children from a rural community of Cajamarca-Peru

et al. 2018

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ObjectiveThe objective of this study was to determine the prevalence of clarithromycin-resistant Helicobacter pylori in asymptomatic children in a rural community of Cajamarca (northern Peru).ResultsHelicobacter pylori was detected in 17.2% (49/285) of the samples. Unboiled water consumption the most frequent associated factor in patients with positive PCR for H. pylori infection (93.9%). Clarithromycin resistant mutations were found in 79.6% (39/49) of the positive samples for H. pylori. The most frequent mutation was A2142G (46.9%), followed by the double-mutation A2142G–A2143G (28.6%).

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Antibiotic Resistance in Helicobacter pylori: A Mutational Analysis from a Tertiary Care Hospital in Kashmir, India

Cited by 27 publications

References 34 publications

High primary resistance to metronidazole and levofloxacin, and a moderate resistance to clarithromycin in Helicobacter pylori isolated from Karnataka patients

High primary resistance to metronidazole and levofloxacin, and a moderate resistance to clarithromycin in Helicobacter pylori isolated from Karnataka patients

Mutational Analysis of Clarithromycin and Levofloxacin Resistance in Helicobacter pylori from Gastric Biopsy Specimens in a Tertiary Care Hospital in Dhaka, Bangladesh

Highly clarithromycin-resistant Helicobacter pylori infection in asymptomatic children from a rural community of Cajamarca-Peru

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