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Frequency of antibiotic resistance in Helicobacter pylori strains isolated from the northern population of Iran

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Abstract

The purpose of this study was to evaluate the primary resistance rates of recent clinical Helicobacter pylori isolates to the most commonly used antibiotics in Iran. Two hundreds and ten patients presenting with gastric maladies between January and July of 2009 were enrolled in this study. Endoscopy was performed, and biopsy specimens were collected from each patient for subsequent bacterial culture of H. pylori. Single colony isolates from each patient were then used for antimicrobial susceptibility testing. The disk diffusion method was used to determine susceptibility patterns. One hundred and ninety-seven of the patients were H. pylori positive (93.8%). The rates of resistance to tetracycline, amoxicillin, ciprofloxacin, metronidazole, clarithromycin, and furizoladone were 37.1%, 23.9%, 34.5%, 65.5%, 45.2%, and 61.4%, respectively. A significant association between amoxicillin resistance and disease state (P<0.05) was identified. Furthermore, some double, triple, quadruple, and quintuple combinations of antibiotic resistance were found to be associated with disease state. This study evaluated the prevalence of H. pylori resistance to the most commonly prescribed antibiotics used in Iran and showed that resistance rates were generally higher than previously reported. This data adds to the growing body of evidence that suggests there is increasing antibiotic resistance among H. pylori isolates, which likely is responsible for the decreasing efficacy of anti-H. pylori therapy at the local and global level. Hence, there is a need for continued monitoring of resistance patterns, especially at the local level, and for incorporation of that information into treatment regimens for H. pylori infections.

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References

  • Agudo, S., G. Perez-Perez, T. Alarcon, and M. Lopez-Brea. 2010. High prevalence of clarithromycin-resistant Helicobacter pylori strains and risk factors associated with resistance in madrid, Spain. J. Clin. Microbiol. 48, 3703–3707.

    Article  PubMed  Google Scholar 

  • Blaser, M.J. 1990. Epidemiology and pathophysiology of Campylobacter pylori infections. Rev. Infect. Dis. 12Suppl 1, S99–106.

    Article  PubMed  Google Scholar 

  • Block, B., G. Schachschal, and H. Schmidt. 2004. Endoscopy of the upper GI tract: A training manual, p. 194. Thieme, Mecical Publishers, Inc., New York, USA.

    Google Scholar 

  • Boyanova, L. and I. Mitov. 2010. Geographic map and evolution of primary Helicobacter pylori resistance to antibacterial agents. Expert Rev. Anti. Infect. Ther. 8, 59–70.

    Article  PubMed  CAS  Google Scholar 

  • Boyanova, L., I. Stancheva, Z. Spassova, N. Katzarov, I. Mitov, and R. Koumanova. 2000. Primary and combined resistance to four antimicrobial agents in Helicobacter pylori in Sofia, Bulgaria. J. Med. Microbiol. 49, 415–418.

    PubMed  CAS  Google Scholar 

  • Dixon, M.F., R.M. Genta, J.H. Yardley, and P. Correa. 1996. Classification and grading of gastritis. The updated sydney system. International workshop on the histopathology of gastritis, Houston 1994. Am. J. Surg. Pathol. 20, 1161–1181.

    Article  PubMed  CAS  Google Scholar 

  • Dunn, B.E., H. Cohen, and M.J. Blaser. 1997. Helicobacter pylori. Clin. Microbiol. Rev. 10, 720–741.

    PubMed  CAS  Google Scholar 

  • Elviss, N.C., R.J. Owen, A. Breathnach, C. Palmer, and N. Shetty. 2005. Helicobacter pylori antibiotic-resistance patterns and risk factors in adult dyspeptic patients from ethnically diverse populations in central and south London during 2000. J. Med. Microbiol. 54, 567–574.

    Article  PubMed  CAS  Google Scholar 

  • Fakheri, H., R. Malekzadeh, S. Merat, M. Khatibian, A. Fazel, B.Z. Alizadeh, and S. Massarrat. 2001. Clarithromycin vs. Furazolidone in quadruple therapy regimens for the treatment of Helicobacter pylori in a population with a high metronidazole resistance rate. Aliment. Pharmacol. Ther. 15, 411–416.

    Article  PubMed  CAS  Google Scholar 

  • Farshad, S., A. Alborzi, A. Japoni, R. Ranjbar, K. Hosseini Asl, P. Badiee, M. Amin Shahidi, and M. Hosseini. 2010. Antimicrobial susceptibility of Helicobacter pylori strains isolated from patients in Shiraz, southern Iran. World J. Gastroenterol. 16, 5746–5751.

    Article  PubMed  Google Scholar 

  • Gao, W., H. Cheng, F. Hu, J. Li, L. Wang, G. Yang, L. Xu, and X. Zheng. 2010. The evolution of Helicobacter pylori antibiotics resistance over 10 years in Beijing, China. Helicobacter 15, 460–466.

    Article  PubMed  Google Scholar 

  • Gisbert, J.P., X. Calvet, A. O’Connor, F. Megraud, and C.A. O’Morain. 2010. Sequential therapy for Helicobacter pylori eradication: A critical review. J. Clin. Gastroenterol. 44, 313–325.

    Article  PubMed  CAS  Google Scholar 

  • Graham, D.Y. and L. Fischbach. 2010. Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut 59, 1143–1153.

    Article  PubMed  CAS  Google Scholar 

  • Horiki, N., F. Omata, M. Uemura, S. Suzuki, N. Ishii, Y. Iizuka, K. Fukuda, and et al. 2009. Annual change of primary resistance to clarithromycin among Helicobacter pylori isolates from 1996 through 2008 in Japan. Helicobacter 14, 86–90.

    Article  PubMed  CAS  Google Scholar 

  • Hulten, K., A. Gibreel, O. Skold, and L. Engstrand. 1997. Macrolide resistance in Helicobacter pylori: Mechanism and stability in strains from clarithromycin-treated patients. Antimicrob. Agents Chemother. 41, 2550–2553.

    PubMed  CAS  Google Scholar 

  • Jones, K.R., J. Cha, and D.S. Merrell. 2008. Who’s winning the war? Molecular mechanisms of antibiotic resistance in Helicobacter pylori. Curr. Drug Ther. 3, 190–203.

    Article  PubMed  CAS  Google Scholar 

  • Kohanteb, J., A. Bazargani, M. Saberi-Firoozi, and A. Mobasser. 2007. Antimicrobial susceptibility testing of Helicobacter pylori to selected agents by agar dilution method in shiraz-iran. Indian J. Med. Microbiol. 25, 374–377.

    Article  PubMed  CAS  Google Scholar 

  • Leodolter, A., M. Kulig, H. Brasch, W. Meyer-Sabellek, S.N. Willich, and P. Malfertheiner. 2001. A meta-analysis comparing eradication, healing and relapse rates in patients with helicobacter pylori-associated gastric or duodenal ulcer. Aliment. Pharmacol. Ther. 15, 1949–1958.

    Article  PubMed  CAS  Google Scholar 

  • Malekzadeh, R., R. Ansari, H. Vahedi, F. Siavoshi, B.Z. Alizadeh, M.R. Eshraghian, A. Vakili, M. Saghari, and S. Massarrat. 2000. Furazolidone versus metronidazole in quadruple therapy for eradication of Helicobacter pylori in duodenal ulcer disease. Aliment. Pharmacol. Ther. 14, 299–303.

    Article  PubMed  CAS  Google Scholar 

  • Malekzadeh, R., M.H. Derakhshan, and Z. Malekzadeh. 2009. Gastric cancer in Iran: Epidemiology and risk factors. Arch. Iran Med. 12, 576–583.

    PubMed  Google Scholar 

  • Malfertheiner, P., F. Megraud, C. O’Morain, F. Bazzoli, E. El-Omar, D. Graham, R. Hunt, T. Rokkas, N. Vakil, and E.J. Kuipers. 2007. Current concepts in the management of Helicobacter pylori infection: The maastricht iii consensus report. Gut 56, 772–781.

    Article  PubMed  CAS  Google Scholar 

  • Marie, M.A.M. 2008. Patterns of Helicobacter pylori resistance to metronidazole, clarithromycin and amoxicillin in Saudi Arabia. J. Bacteriol. Virol. 38, 173–178.

    Article  CAS  Google Scholar 

  • Megraud, F. 2004. H. pylori antibiotic resistance: Prevalence, importance, and advances in testing. Gut 53, 1374–1384.

    Article  PubMed  CAS  Google Scholar 

  • Megraud, F. and P. Lehours. 2007. Helicobacter pylori detection and antimicrobial susceptibility testing. Clin. Microbiol. Rev. 20, 280–322.

    Article  PubMed  CAS  Google Scholar 

  • Mohammadi, M., D. Doroud, N. Mohajerani, and S. Massarrat. 2005. Helicobacter pylori antibiotic resistance in Iran. World J. Gastroenterol. 11, 6009–6013.

    PubMed  CAS  Google Scholar 

  • O’Connor, A., J.P. Gisbert, D. McNamara, and C. O’Morain. 2010. Treatment of Helicobacter pylori infection 2010. Helicobacter 15Suppl 1, 46–52.

    Article  PubMed  Google Scholar 

  • Osato, M.S., R. Reddy, S.G. Reddy, R.L. Penland, H.M. Malaty, and D.Y. Graham. 2001. Pattern of primary resistance of Helicobacter pylori to metronidazole or clarithromycin in the united states. Arch. Intern. Med. 161, 1217–1220.

    Article  PubMed  CAS  Google Scholar 

  • Riahizadeh, S., R. Malekzadeh, S. Agah, N. Zendehdel, R. Sotoudehmanesh, N. Ebrahimi-Dariani, A. Pourshams, and S. Massarrat. 2010. Sequential metronidazole-furazolidone or clarithromycin-furazolidone compared to clarithromycin-based quadruple regimens for the eradication of Helicobacter pylori in peptic ulcer disease: A double-blind randomized controlled trial. Helicobacter 15, 497–504.

    Article  PubMed  CAS  Google Scholar 

  • Saberi-Firoozi, M. and M. Nejabat. 2006. Experiences with Helicobacter pylori treatment in Iran. Iran J. Med. Sci. 31, 181–185.

    Google Scholar 

  • Segura, A.M., O. Gutierrez, W. Otero, A. Angel, R.M. Genta, and D.Y. Graham. 1997. Furazolidone, amoxycillin, bismuth triple therapy for Helicobacter pylori infection. Aliment. Pharmacol. Ther. 11, 529–532.

    Article  PubMed  CAS  Google Scholar 

  • Siavoshi, F., F. Safari, D. Doratotaj, G.R. Khatami, G.H. Fallahi, and M.M. Mirnaseri. 2006. Antimicrobial resistance of Helicobacter pylori isolates from iranian adults and children. Arch. Iran Med. 9, 308–314.

    PubMed  CAS  Google Scholar 

  • Siavoshi, F., P. Saniee, S. Latifi-Navid, S. Massarrat, and A. Sheykholeslami. 2010. Increase in resistance rates of H. pylori isolates to metronidazole and tetracycline-comparison of three 3-year studies. Arch. Iran Med. 13, 177–187.

    PubMed  CAS  Google Scholar 

  • Talebi Bezmin Adabi, A., A. Mohabati Mobarez, A.A.G.H. Ajami, R. Ali Reza, and T. Taghvaei. 2009. Evaluation on antibiotic resistance of Helicobacter pylori isolated from patients admitted to tooba medical center, Sari. J. Mazandaran Univ. Med. Sci. 19, 26–32.

    Google Scholar 

  • Talebi Bezmin Abadi, A., A.M. Mobarez, T. Taghvaei, and L. Wolfram. 2010. Antibiotic resistance of Helicobacter pylori in mazandaran, north of iran. Helicobacter 15, 505–509.

    Article  PubMed  Google Scholar 

  • Vakil, N. and F. Megraud. 2007. Eradication therapy for Helicobacter pylori. Gastroenterology 133, 985–1001.

    Article  PubMed  CAS  Google Scholar 

  • Wolle, K., A. Leodolter, P. Malfertheiner, and W. Konig. 2002. Antibiotic susceptibility of Helicobacter pylori in Germany: Stable primary resistance from 1995 to 2000. J. Med. Microbiol. 51, 705–709.

    PubMed  CAS  Google Scholar 

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Correspondence to Tarang Taghvaei or D. Scott Merrell.

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Supplemental material for this article may be found at http://www.springer.com/content/120956

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Abadi, A.T.B., Taghvaei, T., Mobarez, A.M. et al. Frequency of antibiotic resistance in Helicobacter pylori strains isolated from the northern population of Iran. J Microbiol. 49, 987–993 (2011). https://doi.org/10.1007/s12275-011-1170-6

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  • DOI: https://doi.org/10.1007/s12275-011-1170-6

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