Characterization of clarithromycin heteroresistance among Helicobacter pylori strains isolated from the antrum and corpus of the stomach

Farzi, Nastaran; Behzad, Catherine; Hasani, Zahra; Alebouyeh, Masoud; Zojaji, Homayoun; Zali, Mohammad Reza

doi:10.1007/s12223-018-0637-9

Cited by 16 publications

(10 citation statements)

References 33 publications

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“…From the 131 articles, 65 were excluded for the following reasons: meta‐analysis, review, non‐original research, conference abstract and article without full text (n = 55), and non‐relevant data or no data for susceptibility testing or no resistance data (n = 10). Finally, 66 studies 4,16‐80 were included in this systematic review and meta‐analysis (Supplementary Table ).…”

Section: Resultsmentioning

confidence: 99%

The increasing antimicrobial resistance of Helicobacter pylori in Iran: A systematic review and meta‐analysis

et al. 2020

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Background Antimicrobial resistance of Helicobacter pylori can result in eradication failure. Metadata on the antimicrobial resistance of H pylori in Iran could help to formulate H pylori eradication strategies in Iran. Methods A systematic review was performed after searching in MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Library. A meta‐analysis was performed, and a comparison of the rates between children and adults; time periods (1999‐2010, 2011‐2016, 2017‐2019); and the methods used was carried out. Results A total of 66 studies investigating 5936 H pylori isolates were analyzed. The weighted pooled resistance (WPR) rates were as follows: clarithromycin 21% (95% CI 16‐26), metronidazole 62% (95% 57‐67), clarithromycin in combination with metronidazole 16% (95% CI 10‐23), ciprofloxacin 24% (95% CI 15‐33), levofloxacin 18% (95% CI 9‐30), erythromycin 29% (95% CI 12‐50), furazolidone 13% (95% CI 4‐27), tetracycline 8% (95% CI 5‐13), and amoxicillin 15% (95% CI 9‐22). During the three time periods, there was an increased resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline (P ˂ .05). Furazolidone and a clarithromycin/metronidazole combination had the higher resistance rates in children (P ˂ .05). Conclusion An increasing rate of resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline in Iranian H pylori isolates was identified. In children, the resistance to furazolidone and a combination of clarithromycin and metronidazole is higher compared to adults. As a stable, high resistance to metronidazole was found in children and adults in all Iranian provinces, we suggest that metronidazole should not be included in the Iranian H pylori eradication scheme.

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Section: Resultsmentioning

confidence: 99%

The increasing antimicrobial resistance of Helicobacter pylori in Iran: A systematic review and meta‐analysis

et al. 2020

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“…[35][36][37] These genetic traits might promote the coexistence of several strains with different antibiotic Typing CLA AMX LVX TET MET G9 R S S S S G9-1 1 ABD R S S S S G9-2 ABD R S S S S G9-3 ABD R S S S susceptibilities or different genotypes colonizing a single host, which is defined as H. pylori heterogeneity, and has been reported in several studies. 29,31,38,39 In this study, RAPD-PCR and cagA typing was used for distinguishing the heterogeneity of intra-patient strains of H. pylori. Among several genotyping methods applied to H. pylori, RAPD-PCR is considered to be ideal, because it is a simple, rapid, and low-cost means of distinguishing H. pylori isolates.…”

Section: Discussionmentioning

confidence: 99%

“…18,31,33,34,[41][42][43][44][45][46][47] Bacterial infection resulting in more than one RAPD-PCR banding pattern within an individual patient is considered to indicate mixed infections. 28,31 Farzi et al 39 reported 40 intra-patient H. pylori strains isolated from the antrum and corpus of 97 patients, with isolate diversity in resistance to clarithromycin detected in 17.5% (7/40) of the patients. Additionally, they found that the heteroresistant strains were mostly derived from pre-existing strains in each patient rather than from mixed-type infection.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity of Helicobacter pylori Strains Isolated from Patients with Gastric Disorders in Guiyang, China

Zhu

et al. 2021

IDR

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Chronic Helicobacter pylori infection causes peptic ulcers in a subpopulation of individuals and is a risk factor for the development of gastric cancer. Multiple infections and heteroresistant H. pylori contribute to poor treatment efficacy. Here, we investigated the extent of genetic diversity among H. pylori strains within a given host and its influence on the results of antibiotic (metronidazole, levofloxacin, clarithromycin, amoxicillin, and tetracycline) susceptibility testing. Materials and Methods: Gastric mucosa biopsy samples were obtained from patients with gastric disorders, including 48 H. pylori positive patients, who were never previously treated for H. pylori infection. Five potential H. pylori colonies isolated from each sample were subcultured for enrichment. Enriched H. pylori colonies were identified through Gram staining and assays for urease, oxidase, and catalase. For each H. pylori monoclonal colony, the antibiotic susceptibility was assessed, genomic DNA was sequenced, and the cytotoxinassociated gene A (cagA) genotype was verified. Co-infection with multiple H. pylori strains was determined using random amplified polymorphic DNA (RAPD)-polymerase chain reaction (PCR). Results: Thirteen gastric mucosa biopsy samples were positive for H. pylori. Five monoclonal strains isolated from each of these 13 patients were identified as H. pylori. RAPD-PCR indicated that intra-patient monoclonal strains of H. pylori in 10 of the 13 samples exhibited heterogeneity. Among the 13 patients, intra-patient monoclonal strains isolated from 4 patients had identical cagA genotype, whereas intra-patient monoclonal strains isolated from the other 9 patients harbored more than one cagA genotype. The antibiotic susceptibility of five intra-patient monoclonal strains from seven patients was inconsistent. Conclusion: The existence of heterogeneous H. pylori strains with resistance to different drugs and virulence were common within the gastric mucosa of an individual patient.

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“…strains, which may provide incorrect information for clinical treatment. 6 The genotyping method could significantly shorten the time needed to obtain antibiotic susceptibility data for H. pylori. This method has been explored since 1996.…”

Section: Genotype Profiles Of Helicobacter Pylori From Gastric Biopsimentioning

confidence: 99%

“…4,5 In addition, as a standard method to detect antibiotic susceptibility, the E-test method cannot distinguish heteroresistant Genotype profiles of Helicobacter pylori from gastric biopsies and strains with antimicrobial-induced resistance strains, which may provide incorrect information for clinical treatment. 6 The genotyping method could significantly shorten the time needed to obtain antibiotic susceptibility data for H. pylori. This method has been explored since 1996.…”

Section: Introductionmentioning

confidence: 99%

Genotype profiles of Helicobacter pylori from gastric biopsies and strains with antimicrobial-induced resistance

Wang

Gong

et al. 2020

Therap Adv Gastroenterol

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Background and aims: The genotypic method could significantly shorten the time needed to obtain antibiotic susceptibility data for Helicobacter pylori. The aim of this study was to explore the profile of H. pylori from gastric biopsies and strains with antibiotic-induced resistance. Methods: A total of 124 gastric biopsies were used to perform gene sequencing and to perform bacterial culture and susceptibility testing. Seven susceptible strains were selected to develop resistance to clarithromycin, levofloxacin, and metronidazole. Four susceptible strains were selected to transfer candidate mutations. The genotype profiles of these groups were analyzed by sequencing analysis. The antibiotic susceptibility of these strains was detected using the E-test method. Results: Phenotypic resistance to clarithromycin, levofloxacin, and metronidazole was observed in 35.5%, 40.0%, and 79.8% strains, respectively. Point mutations in 23 S rRNA, gyrA, and rdxA genes were observed in 39.5%, 38.7%, and 86.3% of gastric biopsies, respectively. The A2143G mutation in the 23S rRNA occurs in most clarithromycin-resistant samples. The A2142C point mutation showed a higher efficacy than A2142G and A2143G for inducing clarithromycin resistance. The D91N and N87K mutations in gyrA occurs in most levofloxacin-resistant samples, and double point mutations showed a higher efficacy than single mutations for inducing levofloxacin resistance. Phenotypic resistance and mutations in rdxA lacked consistency. Conclusion: Genotype-based gastric biopsy analysis was reliable for determining clarithromycin and levofloxacin resistance. A2143G in 23S rRNA and N87K/D91N in the gyrA gene occurred in most resistant strains. Mutations in the rdxA gene were not good indicators of metronidazole resistance.

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Characterization of clarithromycin heteroresistance among Helicobacter pylori strains isolated from the antrum and corpus of the stomach

Cited by 16 publications

References 33 publications

The increasing antimicrobial resistance of Helicobacter pylori in Iran: A systematic review and meta‐analysis

The increasing antimicrobial resistance of Helicobacter pylori in Iran: A systematic review and meta‐analysis

Heterogeneity of Helicobacter pylori Strains Isolated from Patients with Gastric Disorders in Guiyang, China

Genotype profiles of Helicobacter pylori from gastric biopsies and strains with antimicrobial-induced resistance

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