Helicobacter pylori from Peptic Ulcer Patients in Uganda Is Highly Resistant to Clarithromycin and Fluoroquinolones: Results of the GenoType HelicoDR Test Directly Applied on Stool (original) (raw)
Related papers
Arquivos de Gastroenterologia, 2016
Background - Antimicrobial resistance is the major factor leading to eradication failure in H. pylori treatment. Molecular tests are useful to detect genetic mutations predictive of clarithromycin and fluoroquinolones resistance. Knowledge of the local prevalence rate of resistance is important to define the best recommended treatment. Objective - To assess the prevalence of primary resistance of H. pylori to clarithromycin and fluoroquinolones, using a molecular test, in a Southeastern urban Brazilian population. Methods - A total of 72 H. pylori seropositive patients [65% female, mean age 39 (19-73) years] never treated before for this infection were studied. All patients underwent gastroscopy in addition to antrum and corpus biopsies and molecular test GenoType HelicoDR (Hain Life Science, Germany) to detect H. pylori and point mutations in genes responsible for clarithromycin and fluoroquinolone resistance. The molecular procedure was divided into three steps: DNA extraction fro...
2019
BACKGROUND: Helicobacter pylori infection is one of the most common chronic bacterial infections of humans and has a worldwide distribution. Epidemiological studies strongly suggested that more than 50% of the world's populations are colonized by H. pylori. Peptic ulcer disease (PUD) is the most common illness in the Ethiopian population visiting outpatient department of health facilities, and it has also been associated with H.pylori infection. The aim of this study was to assess the magnitude of H.pylori and its associated factors among peptic ulcer disease patients who visited at landmark general hospital and adera internal medical speciality center outpatient department. Around 70–90% of peptic ulcer disease (PUD) is due to helicobacter pylori and requires treatment with antimicrobials to which these bacteria are susceptible. OBJECTIVE: To assess the magnitude of helicobacter pylori infection among peptic ulcer diseases pateints of two private health facilites Addis Ababa, E...
Arquivos de Gastroenterologia, 2010
The study aimed at characterizing the mutations in 23S rRNA gene related to Clarithromycin-resistant Helicobacter pylori strains among dyspeptic patients in Khartoum State. Methods: Two hundred gastric biopsies were obtained by endoscopy from 200 patients with dyspepsia. DNA was extracted from culture isolated and relevant mutations in 23S rRNA gene were detected. Results: Out of the 200 biopsies, H. pylori was isolated from 48 (24%) biopsies. Twelve of them were found to be resistant to Clarithromycin. Eight of the resistant strains had both A2143G and A2142G by using restriction enzymes Bsa1and Bbs1. Sequencing the remaining four isolates by PCR detected A2140G mutation.
Antibiotic resistance of Helicobacter pylori from patients in Ile-Ife, South-west, Nigeria
African Health …, 2007
BackgroundHelicobacter pylori has become recognized as a major cause of gastroduodenal diseases in man. Evidence indicates that once acquired, H. pylori persists, usually for life unless eradicated by antimicrobial therapy. Over the past few years, we have accumulated some knowledge of the epidemiology of H. pylori in Ile-Ife, South-West Nigeria. In one collaborative study, we detected H. pylori in 195 (73%) patients referred for endoscopy at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). Furthermore we have observed a variegated gastric inflammatory response and atrophy including atrophic pangastritis but are yet to demonstrate MALToma in any of our patients. In addition we have demonstrated that dental plaque is a possible source of gastric H. pylori infection and such an endogenous source could account for difficulty in eradication leading to re-infection. Presently, infected patients are treated with standard combination therapy made up of amoxycilin and ciprofloxacin with a proton pump inhibitor /bismuth. Reports however have shown that the incidence of antimicrobial resistance in Helicobacter pylori is a growing problem and which has been linked with failures in treatment and eradication. Given this situation it has become necessary to have information about the susceptibility of isolates to particular antimicrobial agents before the selection of an appropriate treatment regimen.ObjectivesMore recently, we sought to study antimicrobial susceptibility of locally isolated H. pylori strains.MethodsWe subjected 32 isolates to antimicrobial susceptibility testing against seven agents.ResultsAll the isolates showed multiple acquired antimicrobial resistance as they were all resistant to amoxicillin, clarithromycin, metronidazole, while 29/31, 27/31 showed resistance to rifampicin and tetracycline respectively. Five (15.6%) of these isolates showed resistance to ciprofloxacin.ConclusionsOur findings suggest that H. pylori strains isolated within our study environment have acquired resistance to all the commonly prescribed antibiotics. On the basis of the findings it would be necessary to re-evaluate the eradication treatment regime in our setting.
2013
Background: Clarithromycin, amoxicillin, and a pump proton inhibitor are the most common drugs recommended as first-line triple therapy for H.pylori treatment, which results in eradication rates close to 80%, varying regionally, principally due to emergency cases and increases of clarithromycin resistant strains. Nucleotide substitutions at the H. pylori domain V of the 23S rRNA fraction are involved in the macrolide resistance and the A2142G and A2143G mutations are predominant in clinical isolates worldwide including in Brazil. As H. pylori culture is fastidious, we investigated the primary occurrence of H. pylori A2142G and A2143G rDNA 23S mutations using a molecular approach directly on gastric biopsies of dyspeptic patients consecutively attended at Hospital das Clinicas of Marilia, São Paulo, Brazil.
Tropical Medicine & International Health, 2008
Objective To determine the prevalence of Helicobacter pylori in patients with gastro-duodenal pathologies and the susceptibility patterns of isolates to the currently recommended antibiotic treatment regimen used in Cameroon.Methods Consecutive dyspeptic patients referred to Douala General Hospital, Cameroon for endoscopy were recruited in the study. Gastric biopsies were collected from the patients and H. pylori isolated and identified following standard microbiology and biochemical techniques. Antibiotic susceptibility was determined by disk diffusion and agar dilution methods against clarithromycin, tetracycline, amoxicillin and metronidazole. Data were analysed using chi-square test and significance considered at P < 0.05.Results Seventy-one (92.2%) of the 77 patients (mean age 44.5 ± 15.7, range 15–77 years) were positive for H. pylori. The antibiotic susceptibility rates were 56% for tetracycline, 55.3% for clarithromycin, 14.4% for amoxicillin and 6.8% for metronidazole. The prevalence of clarithromycin resistance in males vs. females was 42.1%vs. 46.7%, while for metronidazole it was 89.5%vs. 94.7% (P > 0.05). Antimicrobial susceptibility results also revealed 12 antibiotypes based on resistance to the antimicrobial agents investigated. The resistance pattern, amoxicillin and metronidazole (AMRR METR) was the most common (23.7%) amongst the isolates. More than 60% of the isolates exhibited multi-drug resistance to three or four antibiotics.Conclusion Multi-drug resistance is common against the current treatment regimen in Cameroon and, therefore, calls for urgent studies involving newer and broad spectrum antibiotics to address the problem.Objectif Déterminer la prévalence de Helicobacter pylori chez les patients présentant des pathologies gastro-duodénales et les profils de sensibilité des isolats au régime de traitement par antibiotique actuellement recommandé au Cameroun.Méthodes Les patients dyspeptiques consécutifs référés à l’Hôpital Général de Douala au Cameroun pour une endoscopie ont été recrutés pour l’étude. Des biopsies gastriques ont été prélevées et H. pylori a été isolé et identifié selon des techniques microbiologiques et biochimiques standards. La sensibilité aux antibiotiques a été déterminée par les méthodes de diffusion de disque et de dilution d’agar pour la clarithromycine, la tétracycline, l’amoxicilline et le métronidazole. Les données ont été analysées à l’aide du test de Chi carré et la signification statistique pour P < 0,05.Résultats 92,2% des 77 patients (âge moyen 44,5 ± 15,7; intervalle de 15 -77 ans) étaient positifs pour H. pylori. Les taux de sensibilité aux antibiotiques étaient de 56,15% pour la tétracycline, 55,3% pour la clarithromycine, 14,4% pour l’amoxicilline et 6,8% pour le métronidazole. La prévalence de résistance à la clarithromycine chez les hommes par rapport aux femmes était de 42,1% contre 46,7%, alors que pour le métronidazole, elle était de 89,5% contre 94,7% (P > 0,05). Les résultats de sensibilité aux antimicrobiens ont aussi révélé 12 antibiotypes sur base de la résistance aux agents antimicrobiens investigués. Le profil de résistance «amoxicilline et métronidazole» (AMRR METR) était le plus fréquent (23,7%) parmi les isolats. Plus de 60% des isolats présentaient une multirésistance à trois ou quatre antibiotiques à la fois.Conclusion La multirésistance est courante pour le régime thérapeutique actuel au Cameroun et suscite par conséquent un appel d’urgence pour des études sur de nouveaux antibiotiques à large spectre, afin de lutter contre le problème.Objetivo Determinar la prevalencia de Helicobacter pylori en pacientes con patologías gastro- duodenales y los patrones de susceptibilidad de aislados a los regimenes de tratamiento actualmente recomendados y utilizados en Camerún.Métodos Se reclutaron para endoscopía pacientes dispépticos referidos consecutivamente al Hospital General de Duoala, Camerún. Se recolectaron biopsias gástricas de pacientes y se aislaron e identificaron H. pylori siguiendo técnicas microbiológicas y bioquímicas estándar. La susceptibilidad antibiótica se determinó mediante métodos de difusión de disco y dilución en agar frente a claritromicina, tetraciclina, amoxicilina y metronidazol. Se analizaron los datos utilizando la prueba de chi-cuadrado y se consideró significativo con P < 0.05.Resultados Un 92.2% de 77 pacientes (edad media 44.5 ± 15.7, rango 15 -77 años) eran positivos para H. pylori. Las tasas de susceptibilidad antibiótica eran de 56.15% para tetraciclina, 55.3% para claritromicina, 14.4% para amoxicilina y 6.8% para metronidazol. La prevalencia de la resistencia frente a claritromicina en hombre vs. mujeres era de 42.1% vs. 46.7%, mientras que para metronidazol era 89.5% vs. 94.7% (P > 0.05). Los resultados de susceptibilidad antimicrobiana también revelaron 12 antibiotipos basados en resistencia frente a los agentes antimicrobianos probados. El patrón de resistencia amoxicilina y metronidazol (AMRR METR) era el más común (23.7%) entre los aislados. Más del 60% de los aislados exhibían multi-resistencia a tres de cuatro antibióticos.Conclusión La multi-resistencia es común frente al régimen de tratamiento actual en Camerún y por lo tanto se requieren urgentemente estudios que involucren antibióticos nuevos y de más amplio espectro para solventar el problema.
Detection of Clarithromycin-Resistant Helicobacter pylori in Stool Samples
Journal of Clinical Microbiology, 2003
The recognition of the role of Helicobacter pylori in gastric diseases has led to the widespread use of antibiotics in the eradication of this pathogen. The most advocated therapy, triple therapy, often includes clarithromycin. It is well known that clarithromycin resistance is one of the major causes of eradication failure. The development of a rapid noninvasive technique that could easily be performed on fecal samples and that could also provide information about the antibiotic resistance of this microorganism is therefore advisable. Previous findings have demonstrated that clarithromycin resistance is due to a single point mutation in the 23S rRNA. All the mutations described have been associated with specific restriction sites, namely BsaI (A2143G), MboII (A2142C/G), and HhaI (T2717C). On this basis we have developed a new method, a seminested PCR, allowing screening for clarithromycin resistance of H. pylori directly on stool samples. This method furnished a 783-bp fragment of the 23S rRNA, which was subsequently digested by MboII, BsaI, and HhaI, in order to identify single point mutations associated with clarithromycin resistance. Of a total of 283 stool samples examined, 125 were H. pylori positive and two of them were shown to contain clarithromycin-resistant strains due to the presence of a mutation at position 2717, whereas no PCR products contained mutations at position 2142 or 2143. In order to evaluate the reliability of the new system, we compared the results of restriction analysis of the PCR products with the MICs shown by the H. pylori isolates by culturing gastric biopsies from the same patients.
Peptic ulcer disease in South Ethiopia is strongly associated with Helicobacter pylori
Transactions of the …, 1999
Helicobacterpylori infection was detected in 93% of 174 patients with a peptic ulcer compared with 63% of 116 patients with normal findings k2 = 37.3; P CO.00 1) in a cohort of 834 consecutive patients examined by gastroscopy in Yirga Alem Hospital in south Ethiopia. Fourteen patients were given 14 days' treatment with metronidazole 500 mg t.i.d., doxycycline 100 mg b.i.d. and bismuth subnitrate mixture 150 mg q.i.d. Of 10 patients who returned for follow-up, only 2 patients were free from H. pylon' and cured. Nineteen strains of H. pylotifiom 19 consecutive patients in the same hospital were tested for resistance in vitro against metronidazole, doxycycline and ampicillin. All but 1 were highly resistant to metronidazole; 2 were fully and 14 intermediate resistant against doxycycline. All strains were fully sensitive in vitro to ampicillin. Thus, peptic ulcer was strongly associated with H. pylot-i in south Ethiopia, but eradication of the infection was hampered by antibiotic resistance.
Helicobacter pylori: prevalence and antibiotic susceptibility among Kenyans
2010
BACKGROUND Helicobacter pylori infection in Kenya is staggeringly high. Evidence links infection of the gastric mucosa by H. pylori with subsequent development of gastric pathologies. AIM We investigated the prevalence of H. pylori in dyspeptic patients, its relationship with gastric pathologies, and associated antibiotic susceptibility profiles, and compared two media to find the appropriate medium that enhances growth and expedites culture and isolation. METHODS Rapid urease and histological tests were used to screen for H. pylori. Culture was performed to test sensitivity and evaluate media. Selective and nutritional supplements were added to culture media (Colombia blood agar and brain-heart infusion agar) for growth enhancement. E-test strips for metronidazole, amoxicillin and clarithromycin were used for susceptibility testing. RESULTS The prevalence of H. pylori infection in children was 73.3%, and 54.8% in adults. All the H. pylori investigated in this study were largely sen...
European journal of health sciences, 2022
Helicobacter pylori has been implicated in most severe cases of peptic ulcer. Despite this development, the diagnosis of this infection has been a major challenge due to the difficulty encountered during isolation using the conventional culture method. Presently, most health facilities in rural communities in Nigeria still adopt the culture method as the gold standard technique for the diagnosis of H. pylori infections. The need for the introduction of more accurate, robust and rapid diagnostic techniques is therefore imperative. This study was carried out to compare the overall performance of two diagnostic methods in the assessment of Helicobacter pylori infection status among peptic ulcer suspected patients attending health facilities in Lafia, Nigeria, using stool antigen immunoassay test and blood antibody test methods. Methodology: A total of 180 patients with peptic ulcer symptoms attending three health facilities (80 from DASH and 50 each from Jafamek Diagnostic Centre and Haske Hospital) were recruited by designated health workers through random selection using non-probability and convenience sampling. The blood and stool samples of each participant were screened using H. pylori antibody/ antigen test strips (Azure Biotech Inc). The stool samples were cultured on Brain Heart Infusion agar (Oxoid, UK) and the result used as a gold standard in this study. Data obtained were presented as frequencies and association between test methods analysed using contingency chi-square test and Cohen kappa statistics. Results: The outcome of the study showed that out of the 180 participants screened, 51 (28.33%) were positive using the culture method (CM), 111 (61.67%) were reactive for Helicobacter pylori blood antibody test (BAB), while 86 (47.78%) were positive for Helicobacter pylori stool antigen test (SAG). The sensitivity and specificity of the two methods were recorded as 74.50%, 44.20% and 70.60%, 61.20% for BAB and SAG respectively. The level of agreement according to the value of kappa was found to be poor with BAB but fair with SAG. Conclusion: Based on the findings of this study, the overall prevalence of H. pylori infection among the patients was relatively low compared to values obtained from other areas in Nigeria. Also, the stool antigen analytical method had the highest diagnostic accuracy compared to the serum antibody and culture techniques. Recommendation: The stool antigen method is considered the most effective in the diagnosis of Helicobacter pylori infections in the study community and should therefore be used regularly as first choice option.