JCM Accepts, published online ahead of print on 26 November 2014 J. Clin. Microbiol. doi:10.1128/JCM.03001-14 Copyright © 2014, American Society for Microbiology. All Rights Reserved.
Title page
1
Trends in secondary antibiotic resistance of Helicobacter pylori 2007-2014- has
2
the tide turned?
3
Doron Boltina MBBS, Haim Ben-Zvib PhD, Tsachi Tsadok Peretsc PhD, Zvi
4
Kamenetskya MD, Zmira Samrab PhD, Ram Dickmana MD, Yaron Niva MD, FACG,
5
AGAF
6
a
7
Department of Gastroenterology, Rabin Medical Center, Israel, Sackler Faculty of
Medicine, Tel Aviv University, Israel.
8
b
Department of Clinical Microbiology, Rabin Medical Center, Israel.
9
Gastroenterology Laboratory, Rabin Medical Center, Israel.
10
c
Running title: Trends in Hp antibiotic resistance
11
Address for Correspondence:
12
Dr. Doron Boltin, MBBS
13
Division of Gastroenterology, Rabin Medical Center,
14
39 Jabotinski Street, Petah Tikva, Israel 49100
15
Tel: 972-3-9377236; Fax: 972-3-9210313;
16
E-mail: [email protected]
17
Author contributions: DB prepared the manuscript and designed the study, HB and ZS
18
retrieved the data, TTP and ZK provided technical assistance, RD and YN oversaw
19
implementation at all stages.
20
The authors have no conflicts of interest to disclose. No funding was received for the
21
preparation of this manuscript.
22
The authors wish to acknowledge Ms Nili Golan for her assistance in data processing
23
and Dr Haim Shmuely for his assistance in data acquisition.
24
25
Abstract
26
Background: Current guidelines recommend culture and antibiotic susceptibility
27
testing of H. pylori following two failed eradication attempts. Where unavailable,
28
epidemiological data for secondary H. pylori resistance are essential to allow for the
29
rational use of antibiotics. The aim of this study was to describe the temporal changes
30
in antibiotic resistance among adults previously treated for H. pylori, and to identify
31
predictors of resistance.
32
Methods: Between 2007 and 2014, consecutive patients undergoing gastroscopy with
33
H. pylori culture and susceptibility testing at our institution following at least 2
34
treatment failures, were retrospectively identified. Antibiotic susceptibility was
35
recorded and linked to demographic data.
36
Results: 1042 patients were identified, including 739 (70.9%) males, aged 39.3±18.9
37
years. Resistance to clarithromycin, metronidazole and levofloxacin was found in
38
57.2%, 64.4% and 5.1% of isolates, respectively. Dual resistance to clarithromycin
39
and metronidazole was seen in 39.9%. Over the study period, clarithromycin
40
resistance increased annually in a linear manner (OR, 1.09; 95% CI, 1.03-1.14;
41
p1 mg/L; CLA, MIC >0.5 mg/L; MET, MIC
118
≥8 mg/L (8), and LEV, MIC >1 mg/L (9). Hp ATCC 43526 strain was used for
119
quality control of the selective medium and ATCC 43504 strain for the quality control
120
of the susceptibility assay (10). Susceptibility testing for amoxicillin and tetracycline
121
was not performed subsequent to 1st March 2009 due to overwhelming susceptibility
122
of Hp to these agents.
123
Statistical Analysis
124
All analyses were performed using SPSS version 21.0 statistical analysis software
125
(IBM Inc, Chicago, IL, USA). Distributions of continuous variables were assessed for
126
normality using the Kolmogorov-Smirnov test (cutoff at p
Title page
1
Trends in secondary antibiotic resistance of Helicobacter pylori 2007-2014- has
2
the tide turned?
3
Doron Boltina MBBS, Haim Ben-Zvib PhD, Tsachi Tsadok Peretsc PhD, Zvi
4
Kamenetskya MD, Zmira Samrab PhD, Ram Dickmana MD, Yaron Niva MD, FACG,
5
AGAF
6
a
7
Department of Gastroenterology, Rabin Medical Center, Israel, Sackler Faculty of
Medicine, Tel Aviv University, Israel.
8
b
Department of Clinical Microbiology, Rabin Medical Center, Israel.
9
Gastroenterology Laboratory, Rabin Medical Center, Israel.
10
c
Running title: Trends in Hp antibiotic resistance
11
Address for Correspondence:
12
Dr. Doron Boltin, MBBS
13
Division of Gastroenterology, Rabin Medical Center,
14
39 Jabotinski Street, Petah Tikva, Israel 49100
15
Tel: 972-3-9377236; Fax: 972-3-9210313;
16
E-mail: [email protected]
17
Author contributions: DB prepared the manuscript and designed the study, HB and ZS
18
retrieved the data, TTP and ZK provided technical assistance, RD and YN oversaw
19
implementation at all stages.
20
The authors have no conflicts of interest to disclose. No funding was received for the
21
preparation of this manuscript.
22
The authors wish to acknowledge Ms Nili Golan for her assistance in data processing
23
and Dr Haim Shmuely for his assistance in data acquisition.
24
25
Abstract
26
Background: Current guidelines recommend culture and antibiotic susceptibility
27
testing of H. pylori following two failed eradication attempts. Where unavailable,
28
epidemiological data for secondary H. pylori resistance are essential to allow for the
29
rational use of antibiotics. The aim of this study was to describe the temporal changes
30
in antibiotic resistance among adults previously treated for H. pylori, and to identify
31
predictors of resistance.
32
Methods: Between 2007 and 2014, consecutive patients undergoing gastroscopy with
33
H. pylori culture and susceptibility testing at our institution following at least 2
34
treatment failures, were retrospectively identified. Antibiotic susceptibility was
35
recorded and linked to demographic data.
36
Results: 1042 patients were identified, including 739 (70.9%) males, aged 39.3±18.9
37
years. Resistance to clarithromycin, metronidazole and levofloxacin was found in
38
57.2%, 64.4% and 5.1% of isolates, respectively. Dual resistance to clarithromycin
39
and metronidazole was seen in 39.9%. Over the study period, clarithromycin
40
resistance increased annually in a linear manner (OR, 1.09; 95% CI, 1.03-1.14;
41
p1 mg/L; CLA, MIC >0.5 mg/L; MET, MIC
118
≥8 mg/L (8), and LEV, MIC >1 mg/L (9). Hp ATCC 43526 strain was used for
119
quality control of the selective medium and ATCC 43504 strain for the quality control
120
of the susceptibility assay (10). Susceptibility testing for amoxicillin and tetracycline
121
was not performed subsequent to 1st March 2009 due to overwhelming susceptibility
122
of Hp to these agents.
123
Statistical Analysis
124
All analyses were performed using SPSS version 21.0 statistical analysis software
125
(IBM Inc, Chicago, IL, USA). Distributions of continuous variables were assessed for
126
normality using the Kolmogorov-Smirnov test (cutoff at p
