Ann Lab Med.  2013 Nov;33(6):415-419. 10.3343/alm.2013.33.6.415.

Antibiotic Resistance in Helicobacter pylori Strains and its Effect on H. pylori Eradication Rates in a Single Center in Korea

• An B
• Moon BS
• Kim H
• Lim HC
• Lee YC
• Lee G
• Kim SH
• Park M
• Kim JB

• KMID: 1711314
• DOI: http://doi.org/10.3343/alm.2013.33.6.415

Abstract

BACKGROUND
Clarithromycin, amoxicillin, metronidazole, tetracycline, and levofloxacin have been commonly used for the eradication of Helicobacter pylori. We compared the change in antibiotic resistance of H. pylori strains during two separate periods and investigated the effect of antibiotic resistance on H. pylori eradication.
METHODS
H. pylori strains were isolated from 71 patients between 2009 and 2010 and from 94 patients between 2011 and 2012. The distribution of minimal inhibitory concentration (MIC) of 5 antibiotics was assessed using the agar dilution method, and H. pylori eradication based on the antimicrobial susceptibility of the isolates was investigated retrospectively.
RESULTS
Antibiotic resistance rate against clarithromycin, amoxicillin, tetracycline, metronidazole, and levofloxacin for the 2009-2010 isolates were 7.0% (5/71), 2.8% (2/71), 0% (0/71), 45.1% (32/71), and 26.8% (19/71), respectively, and for the 2011-2012 isolates were 16.0% (15/94), 2.1% (2/94), 0% (0/94), 56.3% (53/94), and 22.3% (21/94), respectively. Multi-drug resistance for 2 or more antibiotics increased slightly from 16.9% (12/71) in the 2009-2010 isolates to 23.4% (22/94) in the 2011-2012 isolates. In follow-up testing of 66 patients, first-line treatment successfully eradicated H. pylori in 50 patients (75.8%) and failed in 4 of 7 patients (57.1%) in a clarithromycin-resistant and amoxicillin-susceptible group.
CONCLUSIONS
We observed an increase in resistance to clarithromycin and an overall increase in multi-drug resistance during the 2 study periods. The effectiveness of the eradication regimen was low with combinations of clarithromycin and amoxicillin, particularly in the clarithromycin-resistant group. Thus, eradication of H. pylori depends upon periodic monitoring of antimicrobial susceptibility.

Keyword

Helicobacter pylori; Antibiotic resistance; Eradication

MeSH Terms

Adult
Aged
Anti-Bacterial Agents/*pharmacology/therapeutic use
Drug Resistance, Multiple, Bacterial/*drug effects
Female
Helicobacter Infections/drug therapy/*microbiology
Helicobacter pylori/*drug effects/isolation & purification
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Peptic Ulcer/diagnosis/microbiology
Republic of Korea
Retrospective Studies
Treatment Outcome
Anti-Bacterial Agents

Figure

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  Fig. 1 Antibiotic resistance in H. pylori strains isolated during 2009-2010 and 2011-2012. Increased antibiotic resistance was notable in clarithromycin and metronidazole, although there was no statistical difference.

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  Fig. 2 Distribution of minimal inhibitory concentration (MIC) for Helicobacter pylori isolates. The dotted line indicates the break point for each antibiotic.

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