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Pei Y, Ang D, Kwek ABE, Ang TL. The changing profile of Helicobacter pylori primary antibiotic resistance in Singapore over two decades. J Dig Dis 2022; 23:295-301. [PMID: 35849105 DOI: 10.1111/1751-2980.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 12/11/2022]
Abstract
ObjectivesAntibiotic resistance is a key reason for Helicobacter pylori (H. pylori) treatment failure and updated local data are important to guide the choice of empiric first‐line therapy. Clarithromycin‐based triple therapy (TT) is currently the first‐line treatment in Singapore. Our primary aim was to determine the change in pattern of primary antibiotic resistance of H. pylori in Singapore as well as TT success rate.MethodsA registry of H. pylori isolates was tested for primary antibiotic resistance and were analyzed from year 2001 to 2020. Treatment outcome data based on 13C‐urea breath test (13C‐UBT) results of empiric first‐line 2‐week TT from 2019 to 2020 were also analyzed retrospectively.ResultsA total of 387 H. pylori isolates were included. Rates of resistance to clarithromycin as well as tetracycline showed a downtrend in the last 5 years (clarithromycin: 2001–2002: 8.57%; 2007–2008: 14.14%; 2013–2014: 18.09%; 2019–2020: 13.71%; tetracycline: 2001–2002: 5.71%; 2007–2008: 7.07%; 2013–2014: 7.45%; 2019–2020: 0%). The resistance rate for amoxicillin remained low (2001–2002: 2.86%; 2007–2008: 5.05%; 2013–2014: 4.26%; 2019–2020: 7.26%). There was a steady increase in the rate of levofloxacin resistance (2001–2002: 5.71%; 2007–2008: 11.11%; 2013–2014: 15.96%; 2019–2020: 16.94%). From 2019 to 2020, the rate of successful TT was 91.67% (891/972).ConclusionThe latest rate of clarithromycin resistance in 2019 to 2020 remained below the threshold of 15% and eradication rates remain high; thus, TT remains appropriate as an empiric first‐line treatment in Singapore.
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Affiliation(s)
- Yiying Pei
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
| | - Daphne Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
| | - Andrew Boon Eu Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
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Mansour-Ghanaei F, Poostizadeh G, Joukar F, Siavoshi F. Efficacy of Disc Diffusion and Agar Dilution Methods in Evaluating Helicobacter pylori Susceptibility to Antibiotics. Middle East J Dig Dis 2022; 14:207-213. [PMID: 36619148 PMCID: PMC9489305 DOI: 10.34172/mejdd.2022.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/01/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND: In this study, efficacy and consistency of disc diffusion (DD) and agar dilution (AD) methods in determining Helicobacter pylori susceptibility to antibiotics were evaluated using Brucella blood agar (BBA) in both methods and tetrazolium egg yolk agar (TEYA) in AD. METHODS: Twenty H. pylori isolates were tested for susceptibility to nine antibiotics; metronidazole (MTZ), clarithromycin (CLR), amoxicillin (AMX), tetracycline (TET), ofloxacin (OFX), levofloxacin (LVX), ciprofloxacin (CIP), furazolidone (FRZ), and rifampin (RIF). Antibiotics solutions were impregnated into blank paper disks on BBA in the DD method or added to BBA (ADB) or TEYA (ADT) media in the AD method. Suspensions of H. pylori isolates were surface or spot inoculated on solid media. Plates were incubated in CO2 incubator at 37°C for 5-7 days. RESULTS: The highest rate of susceptibility to MTZ (65%) was determined by DD method compared with AD method (ADB: 40%, ADT: 30%). Both methods showed similar CLR (85%) and AMX (100%) susceptibility rates. Susceptibility to remaining antibiotics, determined by DD and ADB/ADT media were in respective order as 95%, 75% / 75% for TET, 100%, 95% / 85% for FRZ, 85%, 85% / 75% for OFX, 90%, 95% / 85% for LVX, 90%, 85% / 85% for CIP, and 100%, 85% / 75% for RIF. CONCLUSION: DD and AD methods showed consistency in determining 161 (89.4%) susceptibility and resistance and inconsistency in determining 19 (10.6%) susceptibility and resistance (P < 0.05). DD is recommended as a cheap and easy method with the efficacy and precision comparable to the AD method in determining H. pylori susceptibility to antibiotics.
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Affiliation(s)
- Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences, Rasht, Iran
| | - Gelareh Poostizadeh
- Department of Microbiology, School of Biology, University College of Sciences, Tehran University, Tehran, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences, Rasht, Iran
| | - Farideh Siavoshi
- Department of Microbiology, School of Biology, University College of Sciences, Tehran University, Tehran, Iran,Corresponding Author: Farideh Siavoshi, PhD Department of Microbiology, School of Biology, University College of Sciences, University of Tehran, Enghelab Avenue, Tehran 14176-14411, Iran. Tel:+ 9821 61112460 Fax:+ 98 21 66492992
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Lee KH, Park SY, Jeong SJ, Jung DH, Kim JH, Jeong SH, Kang IM, Song YG. Can Aminoglycosides Be Used as a New Treatment for Helicobacter pylori? In vitro Activity of Recently Isolated Helicobacter pylori. Infect Chemother 2019; 51:10-20. [PMID: 30941933 PMCID: PMC6446016 DOI: 10.3947/ic.2019.51.1.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/19/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Smectite can serve as a drug delivery system and gentamicin-intercalated smectite hybrids are expected to supersede the standard therapy for Helicobacter pylori eradication. The aim of this study was to confirm whether the minimum inhibitory concentration (MIC) of aminoglycosides applied as smectite hybrids remained low against recently isolated H. pylori strains. MATERIALS AND METHODS A total of 140 strains were collected for a minimum period of 3 years. Antimicrobial susceptibility tests were performed, and the MICs of eight antibiotics (amoxicillin, clarithromycin, metronidazole, tetracycline, levofloxacin, gentamicin, netilmicin, and tobramycin) were determined by using the Epsilometer test and following the European Committee on Antimicrobial Susceptibility Testing recommendations. RESULTS The resistance rate of clarithromycin was high, up to 30.7%, although it is a major antimicrobial agent used in standard therapy. The MIC₅₀ and MIC₉₀ of gentamicin (0.25 mg/L and 0.75 mg/L) and netilmicin (0.19 mg/L and 0.75 mg/L) were lower than other alternative therapies for H. pylori eradication. In clarithromycin-resistant strains, the MIC₅₀ was 0.25 mg/L and the MIC₉₀ was 1 mg/L for gentamicin; for netilmicin, the values were 0.25 mg/L and 0.75 mg/L, respectively. CONCLUSION Through the use of gentamicin and netilmicin, which have low MICs for H. pylori, aminoglycoside-intercalated smectite hybrids are expected to emerge as a new standard therapy for H. pylori eradication.
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Affiliation(s)
- Kyoung Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Young Park
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Da Hyun Jung
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jie Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Il Mo Kang
- Korea Institute of Geoscience and Mineral Resources, Daejeon, Korea.
| | - Young Goo Song
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Ang TL, Fock KM, Ang D, Kwek ABE, Teo EK, Dhamodaran S. The Changing Profile of Helicobacter pylori Antibiotic Resistance in Singapore: A 15-Year Study. Helicobacter 2016; 21:261-5. [PMID: 26774006 DOI: 10.1111/hel.12291] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Antibiotic resistance is an important cause of H. pylori treatment failure. This study aimed to examine the change in H. pylori antibiotic resistance profile in Singapore over the course of 15 years. MATERIALS AND METHODS The study period was from 2000 to 2014. Gastric mucosal biopsies obtained from H. pylori-positive patients were cultured. Antibiotic susceptibility to metronidazole, clarithromycin, levofloxacin, tetracycline, and amoxicillin was tested. The change in resistance rates over time was analyzed. RESULTS A total of 708 H. pylori isolates were cultured. There was a significant increase in resistance rates for metronidazole (2000-2002: 24.8%; 2012-2014: 48.2%; p < .001), clarithromycin (2000-2002: 7.9%; 2012-2014: 17.1%; p = .022), and levofloxacin (2000-2002: 5%; 2012-2014: 14.7%; p = .007). The resistance rates for tetracycline (2000-2002: 5%; 2012-2014: 7.6%) and amoxicillin (2000-2002: 3%; 2012-2014: 4.4%) remained stable. Increase in dual (2000-2002: 6.9%; 2012-2014: 9.4%; p = .479) and triple antibiotic resistance rates (2000-2002: 0; 2012-2014: 7.6%; p < .001) were observed. Overall, the most common dual and triple resistance patterns were metronidazole/clarithromycin (4.4%) and metronidazole/clarithromycin/levofloxacin (1.8%), respectively. CONCLUSIONS Over 15 years, H. pylori resistance rates to metronidazole, clarithromycin and levofloxacin had increased. There was increased resistance to multiple antibiotics.
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Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Kwong Ming Fock
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Daphne Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Andrew Boon Eu Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Eng Kiong Teo
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Subbiah Dhamodaran
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
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Antimicrobial susceptibility testing of Helicobacter pylori determined by microdilution method using a new medium. Curr Microbiol 2009; 58:559-63. [PMID: 19198938 DOI: 10.1007/s00284-009-9368-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 01/08/2009] [Accepted: 01/08/2009] [Indexed: 01/06/2023]
Abstract
Antibiotic susceptibility testing of Helicobacter pylori isolates was performed by broth microdilution method with MegaCell RPMI-1640 Medium (SIGMA). Fifty five clinical isolates of H. pylori were tested against metronidazole, tinidazole, amoxicillin, and clarithromycin. The results were compared to those obtained by standard agar dilution method. The microdilution method performed with new medium, showed excellent correlation with agar dilution results, with 100% agreement for metronidazole, 96.3% for amoxicillin, 90.7% for clarithromycin, and 92.8% for tinidazole. MICs determined by proposed method were highly reproducible: replicate results were variable within one-two-fold dilution by using different inocula and different batches of medium.
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Mondino PJJ, Netto Dos Santos KR, do Carmo de Freire Bastos M, Giambiagi-deMarval M. Improvement of mupirocin E-test for susceptibility testing of Staphylococcus aureus. J Med Microbiol 2003; 52:385-387. [PMID: 12721313 DOI: 10.1099/jmm.0.05011-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Interpretation of the mupirocin E-test for low-level mupirocin-resistant Staphylococcus aureus strains has been improved by adding the indicator dye tetrazolium. E-tests were compared with agar dilution methods for assessing mupirocin susceptibility. MICs obtained by the agar dilution method and E-tests showed 89.3% agreement within 2 log(2) dilution criteria. The agreement between MICs increased to 100% in the 1 log(2) dilution definition when the indicator dye tetrazolium was added to the E-test. The use of the E-test with tetrazolium reduction is more accurate for determining mupirocin MICs for S. aureus strains.
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Affiliation(s)
- Pedro Juan José Mondino
- Instituto de Microbiologia Prof. Paulo de Góes, Universidade Federal do Rio de Janeiro, Brazil 2Departamento de Patologia, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Kátia Regina Netto Dos Santos
- Instituto de Microbiologia Prof. Paulo de Góes, Universidade Federal do Rio de Janeiro, Brazil 2Departamento de Patologia, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Maria do Carmo de Freire Bastos
- Instituto de Microbiologia Prof. Paulo de Góes, Universidade Federal do Rio de Janeiro, Brazil 2Departamento de Patologia, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Marcia Giambiagi-deMarval
- Instituto de Microbiologia Prof. Paulo de Góes, Universidade Federal do Rio de Janeiro, Brazil 2Departamento de Patologia, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
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Grignon B, Tankovic J, Mégraud F, Glupczynski Y, Husson MO, Conroy MC, Emond JP, Loulergue J, Raymond J, Fauchère JL. Validation of diffusion methods for macrolide susceptibility testing of Helicobacter pylori. Microb Drug Resist 2002; 8:61-6. [PMID: 12002651 DOI: 10.1089/10766290252913773] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Helicobacter pylori resistance to macrolides is increasing, and the need for susceptibility testing has become crucial. The only standardized method is agar dilution, which is not adapted to clinical practice. The present work aimed: (1) to optimize the technical conditions and to assess the reproducibility of the E-test and disk diffusion method for macrolides susceptibility testing of H. pylori, and (2) to assess the performances of these two phenotypic methods in detecting strains harboring a resistance mechanism to macrolides. We used 191 isolates collected in nine centers of France and Belgium. Phenotypic tests were performed on Mueller-Hinton agar supplemented with 10% horse blood, inoculated with a 2-day-old H. pylori suspension (10(8) CFU/ml), and incubated for 72 hr at 37 degrees C under microaerophilic conditions. The reproducibility studied on two randomly selected strains was better for disk diffusion than for the E-test for both clarithromycin and erythromycin. For a subset of 10 strains, the MICs of erythromycin and clarithromycin did not differ from more than one two-fold dilution when determined by E-test or agar dilution method. The breakpoints were for MICs: 1 mg/L for both clarithromycin and erythromycin and for inhibition diameters, 22 mm for clarithromycin and 17 mm for erythromycin. There was a 100% concordance between susceptibility to erythromycin and clarithromycin. However, the susceptible and resistant populations were better separated by testing erythromycin. Of 34 resistant strains, two lacked the A2142G and A2143G point mutations in 23S rRNA by PCR-RFLP. None of 15 tested sensitive strains were positive for one of these two point mutations. For clinical practice, we recommend to assess macrolide susceptibility of H. pylori by using one of these two phenotypic methods under the described technical conditions.
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Crespo A, Suh B. Helicobacter pylori infection: epidemiology, pathophysiology, and therapy. Arch Pharm Res 2001; 24:485-98. [PMID: 11794521 DOI: 10.1007/bf02975151] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Helicobacter pylori is one of the most commonly encountered human pathogens. It has been shown to be closely associated with peptic ulcer disease (PUD), gastric adenocarcinoma, and the gastric mucosa-associated lymphoid tissue (MALT) that may lead to gastric lymphoma. The current diagnostic methods include histology, microbiological culture, classic serology, urease activity detection, polymerase chain reaction (PCR) and stool antigen detection. Its treatment modality options are multiple; however, a triple regimen consisting of a proton pump inhibitor (PPI), and two antibiotics for 10 to 14 days is preferred. Drug resistance is a growing problem in this organism and new therapeutic options are currently limited.
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Affiliation(s)
- A Crespo
- Section of Infectious Diseases, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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