High clarithromycin resistance of Helicobacter pylori strains isolated from naive patients

Document Type : Original Research

Authors
S. Rezaei
A. Talebi Bazminabadi
A. Mohabbati Mobarez
Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Abstract
Introduction

This study investigates the susceptibility and resistance of H. pylori isolates recovered from gastroduodenal patients naive to clarithromycin.

Methods

To that end, H. pylori strains were isolated from antral biopsies of pretreatment patients, and antral biopsy specimens were subsequently cultured. Presumptive H. pylori colonies were also confirmed on enriched Brucella agar by biochemical tests, including catalase, oxidase, rapid urease, and the standard polymerase chain reaction (PCR) method. The antimicrobial susceptibility testing was performed by standard disk diffusion methods according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Then, the Epsilometer test (E-test) was used to determine the minimal inhibition concentration (MIC).

Results

Of 180 samples, 80 (44%) were positive for urease and were included for further analysis. 65 were also positive in culture base method. The sensitivity test indicated a 23% resistance rate to clarithromycin among the six clarithromycin-resistant strains: four have a common form of the A2143G mutation, and two have A2142G mutation.

Conclusion

The PCR indicated that the level of resistance to clarithromycin was very similar to the resistance level in Iran.

Keywords

Subjects

1. Group IHpW. Helicobacter pylori eradication as a strategy for preventing gastric cancer. Lyon, France: International Agency for Research on Cancer (IARC Working Group Reports, No. 8). 2014.
2. Fallone CA, Chiba N, van Zanten SV, Fischbach L, Gisbert JP, Hunt RH, et al. The Toronto consensus for the treatment of Helicobacter pylori infection in adults. Gastroenterology. 2016;151(1):51-69. e14.
3. Mégraud F. H pylori antibiotic resistance: prevalence, importance, and advances in testing. Gut. 2004;53(9):1374-84.
4. Hashemi SJ, Sheikh AF, Goodarzi H, Yadyad MJ, Seyedian SS, Aslani S, et al. Genetic basis for metronidazole and clarithromycin resistance in Helicobacter pylori strains isolated from patients with gastroduodenal disorders. Infection and Drug Resistance. 2019;12:535.
5. Hwang TJ, Kim N, Kim HB, Lee BH, Nam RH, Park JH, et al. Change in antibiotic resistance of Helicobacter pylori strains and the effect of A2143G point mutation of 23S rRNA on the eradication of H. pylori in a single center of Korea. Journal of clinical gastroenterology. 2010;44(8):536-43.
6. Malfertheiner P, Megraud F, O'morain C, Gisbert J, Kuipers E, Axon A, et al. Management of Helicobacter pylori infection—the Maastricht V/Florence consensus report. Gut. 2017;66(1):6-30.
7. Versalovic J, Shortridge D, Kibler K, Griffy MV, Beyer J, Flamm RK, et al. Mutations in 23S rRNA are associated with clarithromycin resistance in Helicobacter pylori. Antimicrobial agents and chemotherapy. 1996;40(2):477-80.
8. Taneike I, Nami A, O'Connor A, Fitzgerald N, Murphy P, Qasim A, et al. Analysis of drug resistance and virulence‐factor genotype of Irish Helicobacter pylori strains: is there any relationship between resistance to metronidazole and cagA status? Alimentary pharmacology & therapeutics. 2009;30(7):784-90.
9. Chaves S, Gadanho M, Tenreiro R, Cabrita J. Assessment of metronidazole susceptibility in Helicobacter pylori: statistical validation and error rate analysis of breakpoints determined by the disk diffusion test. Journal of clinical microbiology. 1999;37(5):1628-31.
10. Chaabouni H, Bouzid H, Masmoudi A, Cheikh I, Fendri C, Ammar AB. Evaluation in vitro de la resistance primaire de helicobacter pylori aux antibiotiques chez les malades souffrant d'ulcere duodenal en tunisie. Gastroenterologie clinique et biologique. 2004;28:A135-A.
11. Mégraud F. Time to change approaches to Helicobacter pylori management. The Lancet Gastroenterology & Hepatology. 2017;2(10):692-3.
12. Lee Y-C, Chiang T-H, Chou C-K, Tu Y-K, Liao W-C, Wu M-S, et al. Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis. Gastroenterology. 2016;150(5):1113-24. e5.
13. Malfertheiner P. Helicobacter pylori treatment for gastric cancer prevention. Mass Medical Soc; 2018. p. 1154-6.
14. Eyvazi S, Hakemi-Vala M. A review article on Helicobacter pylori antibiotic resistance profile in Iran. Int J Trop Dis Health. 2015;10(1):1-12.
15. Owen R. Molecular testing for antibiotic resistance in Helicobacter pylori. Gut. 2002;50(3):285-9.
16. Rasheed F, Campbell BJ, Alfizah H, Varro A, Zahra R, Yamaoka Y, et al. Analysis of clinical isolates of Helicobacter pylori in Pakistan reveals high degrees of pathogenicity and high frequencies of antibiotic resistance. Helicobacter. 2014;19(5):387-99.
17. Shokrzadeh L, Jafari F, Dabiri H, Baghaei K, Zojaji H, Alizadeh AH, et al. Antibiotic susceptibility profile of Helicobacter pylori isolated from the dyspepsia patients in Tehran, Iran. Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association. 2011;17(4):261.
18. Wueppenhorst N, Stueger H-P, Kist M, Glocker E. Identification and molecular characterization of triple-and quadruple-resistant Helicobacter pylori clinical isolates in Germany. Journal of Antimicrobial Chemotherapy. 2009;63(4):648-53.
19. Alvarez A, Moncayo JI, Santacruz JJ, Santacoloma M, Corredor LF, Reinosa E. Antimicrobial susceptibility and mutations involved in clarithromycin resistance in Helicobacter pylori isolates from patients in the western central region of Colombia. Antimicrobial agents and chemotherapy. 2009;53(9):4022-4.
20. Kim KS, Kang JO, Eun CS, Han DS, Choi TY. Mutations in the 23S rRNA gene of Helicobacter pylori associated with clarithromycin resistance. Journal of Korean Medical Science. 2002;17(5):599-603.
21. Hosseini RS, Rahimian G, Shafigh MH, Validi M, Khaledi M, Gholipour A. Correlation between clarithromycin resistance, virulence factors, and clinical characteristics of the disease in Helicobacter pylori infected patients in Shahrekord, Southwest Iran. AMB Express. 2021;11(1):1-9.
22. Vazirzadeh J, Falahi J, Moghim S, Narimani T, Rafiei R, Karbasizadeh V. Molecular assessment of resistance to clarithromycin in Helicobacter pylori strains isolated from patients with dyspepsia by fluorescent in situ hybridization in the center of Iran. BioMed Research International. 2020;2020.
23. Ierardi E, Giorgio F, Losurdo G, Di Leo A, Principi M. How antibiotic resistances could change Helicobacter pylori treatment: A matter of geography? World Journal of Gastroenterology: WJG. 2013;19(45):8168.
24. Hamidi S, Badmasti F, Sadeghpour Heravi F, Safapoor MH, Mohammad Ali Tabrizi A, Ghorbani M, et al. Antibiotic resistance and clonal relatedness of Helicobacter pylori strains isolated from stomach biopsy specimens in the northeast of Iran. Helicobacter. 2020;25(2):e12684.
25. Zhang Z, Wang Y, Pang Y, Liu C. Comparison of different drug susceptibility test methods to detect rifampin heteroresistance in Mycobacterium tuberculosis. Antimicrobial agents and chemotherapy. 2014;58(9):5632-5.
26. Bahadori A, Gökmen TG, Köksal F, Tumgor G, Agin M, Sadighi A, et al. High prevalence of clarithromycin resistant Helicobacter pylori in Turkish children with gastric disorders. Gene Reports. 2021;24:101275.
Pathobiology Reserach
Volume 26, Issue 2
April 2023
Pages 69-74