Indian Journal of Medical Microbiology, (2014) 32(4): 408-413
1
Original Article
Emerging antimicrobial resistance pattern of Helicobacter pylori in central Gujarat *HB Pandya, Harihar Har Agravat, JS Patel, NRK Sodagar
Abstract Background: Antimicrobial resistance is a growing problem in H. pylori treatment. The study was intended to evaluate the prevalence of resistance amongst 80 H.pylori isolates cultured from biopsy taken during routine endoscopies in 2008-2011. Materials and Methods: 855 gastro duodenal biopsies were collected and cultured on H.pylori selective medium (containing Brucella agar and Columbia agar (Hi media), with Skirrow’s supplement (antibiotic supplement) and 7% human blood cells). H.pylori was isolated from 80 specimens. The antimicrobial susceptibility of H.pylori isolates was carried out by the Kirby Bauer technique against metronidazole (5 µg), clarithromycin (15 µg), ciprofloxacin (5 µg), amoxicillin (10 µg), tetracycline (30 µg), erythromycin (15 µg), levofloxacin (5 µg), and furazolidone (50 µg) (Sigma- Aldrich, MO). Results: 83.8% isolates were resistant to metronidazole, 58.8% were resistant to Clarithromycin 72.5% were resistant to Amoxicillin, 50% to Ciprofloxacin and 53.8% to tetracycline. furazolidone, erythromycin and Levofloxacin showed only 13.8% resistance to H.pylori. Multi drug resistance with metronidazole+ clarithromycin+ tetracycline was 85%. For all the drugs Antimicrobial resistance rate was found higher in males compare to females. Metronidazole and amoxicillin resistance was found noteworthy in patients with duodenal ulcer (p = 0.018), gastritis (P = 0.00), and in reflux esophagitis (P = 0.00). clarithromycin and tetracycline resistance was suggestively linked with duodenitis (P = 0.018), while furazolidone, erythromycin and levofloxacin showed excellent sensitivity in patients with duodenitis (P value- 0.018), gastritis (P= 0.00) and reflux esophagitis (P = 0.00). Resistance with metronidazole (P = 0.481), clarithromycin (P= 0.261), amoxicillin (P = 0.276), tetracycline (P = 0.356), ciprofloxacin (P = 0.164) was not correlated well with Age-group and Gender of the patients. Conclusion: A very high percentage of patients were infected with metronidazole and clarithromycin resistant strains. The use of antibiotics for other indications seems to be the major risk factor for the development of primary resistance. High incidence should alarm the gastroenterologist while prescribing the eradication regimen. Key words: Amoxicillin, clarithromycin, Resistance, metronidazole, H.pylori
Introduction The discovery of Helicobacter pylori species by Warren and Marshall have not only introduced a whole new group of bacteria to science but also revolutionised our concept of gastro duodenal pathology and diverted the worldwide attention from pH (H + ion concentration) to Hp (H. pylori). *Corresponding author (email: ) Assistant Professor (HBP), Department of Medical Microbiology (NRKS), Shree Purshottamdas Moti Bhai Patel. Patel College of Paramedical Science and Technology, Anand, Dean (HHA), chiman bhai odhav bhai Shah Medical College, Surendranagar, Head of the Department (JSP), Purshottam Bhai Dhaya Bhai Patel Institute of Applied Sciences, Charotar University of Science and Technology, Changa, Gujarat, India Received: 10‑05‑2013 Accepted: 16-01-2014 Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.142256
Various epidemiological studies have demonstrated that this organism plays an aetiological role in the development of type B active chronic gastritis;[1] and is likely to be associated with duodenal ulcer in 70-100% of cases and with gastric ulcer in 50-90%. Eradication of this infection with appropriate antibiotic therapy has been shown to decrease ulcer recurrence
1
Original Article
Emerging antimicrobial resistance pattern of Helicobacter pylori in central Gujarat *HB Pandya, Harihar Har Agravat, JS Patel, NRK Sodagar
Abstract Background: Antimicrobial resistance is a growing problem in H. pylori treatment. The study was intended to evaluate the prevalence of resistance amongst 80 H.pylori isolates cultured from biopsy taken during routine endoscopies in 2008-2011. Materials and Methods: 855 gastro duodenal biopsies were collected and cultured on H.pylori selective medium (containing Brucella agar and Columbia agar (Hi media), with Skirrow’s supplement (antibiotic supplement) and 7% human blood cells). H.pylori was isolated from 80 specimens. The antimicrobial susceptibility of H.pylori isolates was carried out by the Kirby Bauer technique against metronidazole (5 µg), clarithromycin (15 µg), ciprofloxacin (5 µg), amoxicillin (10 µg), tetracycline (30 µg), erythromycin (15 µg), levofloxacin (5 µg), and furazolidone (50 µg) (Sigma- Aldrich, MO). Results: 83.8% isolates were resistant to metronidazole, 58.8% were resistant to Clarithromycin 72.5% were resistant to Amoxicillin, 50% to Ciprofloxacin and 53.8% to tetracycline. furazolidone, erythromycin and Levofloxacin showed only 13.8% resistance to H.pylori. Multi drug resistance with metronidazole+ clarithromycin+ tetracycline was 85%. For all the drugs Antimicrobial resistance rate was found higher in males compare to females. Metronidazole and amoxicillin resistance was found noteworthy in patients with duodenal ulcer (p = 0.018), gastritis (P = 0.00), and in reflux esophagitis (P = 0.00). clarithromycin and tetracycline resistance was suggestively linked with duodenitis (P = 0.018), while furazolidone, erythromycin and levofloxacin showed excellent sensitivity in patients with duodenitis (P value- 0.018), gastritis (P= 0.00) and reflux esophagitis (P = 0.00). Resistance with metronidazole (P = 0.481), clarithromycin (P= 0.261), amoxicillin (P = 0.276), tetracycline (P = 0.356), ciprofloxacin (P = 0.164) was not correlated well with Age-group and Gender of the patients. Conclusion: A very high percentage of patients were infected with metronidazole and clarithromycin resistant strains. The use of antibiotics for other indications seems to be the major risk factor for the development of primary resistance. High incidence should alarm the gastroenterologist while prescribing the eradication regimen. Key words: Amoxicillin, clarithromycin, Resistance, metronidazole, H.pylori
Introduction The discovery of Helicobacter pylori species by Warren and Marshall have not only introduced a whole new group of bacteria to science but also revolutionised our concept of gastro duodenal pathology and diverted the worldwide attention from pH (H + ion concentration) to Hp (H. pylori). *Corresponding author (email: ) Assistant Professor (HBP), Department of Medical Microbiology (NRKS), Shree Purshottamdas Moti Bhai Patel. Patel College of Paramedical Science and Technology, Anand, Dean (HHA), chiman bhai odhav bhai Shah Medical College, Surendranagar, Head of the Department (JSP), Purshottam Bhai Dhaya Bhai Patel Institute of Applied Sciences, Charotar University of Science and Technology, Changa, Gujarat, India Received: 10‑05‑2013 Accepted: 16-01-2014 Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.142256
Various epidemiological studies have demonstrated that this organism plays an aetiological role in the development of type B active chronic gastritis;[1] and is likely to be associated with duodenal ulcer in 70-100% of cases and with gastric ulcer in 50-90%. Eradication of this infection with appropriate antibiotic therapy has been shown to decrease ulcer recurrence
