Antibiotic Resistance in Helicobacter pylori Strains and its Effect on H. pylori Eradication Rates in a Single Center in Korea
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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.
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.
참고문헌 (19)
- Sugiyama T, "Sensitivity of biopsy site in evaluating regression of gastric atrophy after Helicobacter pylori eradication treatment", Aliment Pharmacol Ther, 16(S2), pp.S187~S190 (2002)
- Suerbaum S, "Helicobacter pylori infection", N Engl J Med, 347, pp.1175~1186 (2002)
- Malfertheiner P, "Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report", Gut, 56, pp.772~781 (2007)
- 김나영, "헬리코박터 파일로리 감염의 진단 및 치료 가이드라인", 대한소화기학회지, 54(5), pp.269~278 (2009), 대한소화기학회
- Hwang TJ, "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", J Clin Gastroenterol, 44, pp.536~543 (2010)
- 최유식, "Helicobacter pylori 일차 삼제 제균요법의 연도별 제균율 분석: 단일 기관의 최근 8년 성적", 대한소화기학회지, 48(3), pp.156~161 (2006), 대한소화기학회
- 나현식, "Helicobacter pylori 일차 및 이차 치료의 제균율 변화와 재감염률", 대한소화기학회지, 50(3), pp.170~175 (2007), 대한소화기학회
- Clinical and Laboratory Standards Institute, "Performance standards for antimicrobial susceptibility testing. Eighteenth informational supplement, M2-A9, M7-A7, and M100-S18" (2008), Clinical and Laboratory Standards Institute
- Glupczynski Y, "European multicentre survey of in vitro antimicrobial resistance in Helicobacter pylori", Eur J Clin Microbiol Infect Dis, 20, pp.820~823 (2001)
- Kim JM, "Distribution of fluoroquinolone MICs in Helicobacter pylori strains from Korean patients", J Antimicrob Chemother, 56, pp.965~967 (2005)
- 김정목, "2003년 우리나라 환자에서 분리한 Helicobacter pylori 균주의 항생제 내성률", 대한소화기학회지, 44(3), pp.126~135 (2004), 대한소화기학회
- Kim JJ, "Analysis of metronidazole, clarithromycin and tetracycline resistance of Helicobacter pylori isolates from Korea", J Antimicrob Chemother, 47, pp.459~461 (2001)
- Eun CS, "Changing pattern of antimicrobial resistance of Helicobacter pylori in Korean patients with peptic ulcer diseases", J Gastroenterol, 38, pp.436~441 (2003)
- 이혜경, "Multicenter Study for the Frequency of 23S rRNA Point Mutations Associated with Clarithromycin Resistance in Helicobacter pylori in Korea", Annals of Clinical Microbiology, 11(2), pp.84~89 (2008), 대한임상미생물학회
- Queiroz DM, "Factors associated with treatment failure of Helicobacter pylori infection in a developing country", J Clin Gastroenterol, 35, pp.315~320 (2002)
- Kim N, "Institutional difference of antibiotic resistance of Helicobacter pylori strains in Korea", J Clin Gastroenterol, 40, pp.683~687 (2006)
- Versalovic J, "Mutations in 23S rRNA are associated with clarithromycin resistance in Helicobacter pylori", Antimicrob Agents Chemother, 40, pp.477~480 (1996)
- Kim MH, "Analysis of antimicrobial resistance of Helicobacter pylori in Gwangju, Chonnam Provinces", Korean J Helicobacter Up Gastrointest Res, 12, pp.82~87 (2012)
- 김재연, "한국에서 지역에 따른 Helicobacter pylori 균주 내성", 대한소화기학회지, 57(4), pp.221~229 (2011), 대한소화기학회