Molecular characterization and prevalence of antibiotic resistance in Helicobacter pylori isolates in Kuala Lumpur, Malaysia

Alfizah Hanafiah, Hasyanee Binmaeil, Raja Affendi Raja Ali, Isa Mohamed Rose, Bruno S. Lopes

Research output: Contribution to journalArticle

Abstract

Aims and objectives: Helicobacter pylori has been classified as high priority pathogen by the WHO in 2017. The emergence of antibiotic-resistant strains is one of the main causes of treatment failure in H. pylori infection. This study determined and characterized primary and secondary resistances in H. pylori in Malaysia. Materials and methods: Gastric biopsies from antrum (n=288) and corpus (n=283) were obtained from 288 patients who underwent endoscopy at Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia. Antibiotic susceptibility to six classes of antibiotics was determined by the E-test. Mutations conferring in resistance in functional genes were identified by PCR and sequencing. Results: Overall resistance rates to metronidazole, clarithromycin and levofloxacin were 59.3% (35/59), 35.6% (21/59) and 25.4% (15/59), respectively. Secondary isolates showed significantly higher resistance rates to clarithromycin compared to the primary isolates. Mixed infection with susceptible and resistant isolates was observed in 16.2% (6/37) of cases, of which 83.3% (n=5) had infection with the same strain. 41% (18/44) of isolates were resistant to more than one class of antibiotics of which 50% (9/18) were multidrug-resistant, two being primary and seven being secondary isolates. Mutations in rdxA, 23S rRNA and gyrA genes were associated with resistance to metronidazole, clarithromycin and levofloxacin, respectively. Conclusion: The high level of resistance to metronidazole, clarithromycin and levofloxacin seen in H. pylori isolates in our setting warrants the need for continuous surveillance and highlights caution in use of antibiotics generally used as first-line therapy in H. pylori eradication regimen.

Original languageEnglish
Pages (from-to)3051-3061
Number of pages11
JournalInfection and Drug Resistance
Volume12
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

Malaysia
Microbial Drug Resistance
Helicobacter pylori
Clarithromycin
Levofloxacin
Anti-Bacterial Agents
Metronidazole
Pyloric Antrum
Mutation
Helicobacter Infections
Treatment Failure
Coinfection
rRNA Genes
Endoscopy
Biopsy
Polymerase Chain Reaction
Infection
Genes

Keywords

  • Antibiotic resistance
  • Clarithromycin
  • Helicobacter pylori
  • Levofloxacin
  • Metronidazole
  • Point mutation

ASJC Scopus subject areas

  • Pharmacology
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Molecular characterization and prevalence of antibiotic resistance in Helicobacter pylori isolates in Kuala Lumpur, Malaysia. / Hanafiah, Alfizah; Binmaeil, Hasyanee; Ali, Raja Affendi Raja; Rose, Isa Mohamed; Lopes, Bruno S.

In: Infection and Drug Resistance, Vol. 12, 01.01.2019, p. 3051-3061.

Research output: Contribution to journalArticle

Hanafiah, Alfizah ; Binmaeil, Hasyanee ; Ali, Raja Affendi Raja ; Rose, Isa Mohamed ; Lopes, Bruno S. / Molecular characterization and prevalence of antibiotic resistance in Helicobacter pylori isolates in Kuala Lumpur, Malaysia. In: Infection and Drug Resistance. 2019 ; Vol. 12. pp. 3051-3061.
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AB - Aims and objectives: Helicobacter pylori has been classified as high priority pathogen by the WHO in 2017. The emergence of antibiotic-resistant strains is one of the main causes of treatment failure in H. pylori infection. This study determined and characterized primary and secondary resistances in H. pylori in Malaysia. Materials and methods: Gastric biopsies from antrum (n=288) and corpus (n=283) were obtained from 288 patients who underwent endoscopy at Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia. Antibiotic susceptibility to six classes of antibiotics was determined by the E-test. Mutations conferring in resistance in functional genes were identified by PCR and sequencing. Results: Overall resistance rates to metronidazole, clarithromycin and levofloxacin were 59.3% (35/59), 35.6% (21/59) and 25.4% (15/59), respectively. Secondary isolates showed significantly higher resistance rates to clarithromycin compared to the primary isolates. Mixed infection with susceptible and resistant isolates was observed in 16.2% (6/37) of cases, of which 83.3% (n=5) had infection with the same strain. 41% (18/44) of isolates were resistant to more than one class of antibiotics of which 50% (9/18) were multidrug-resistant, two being primary and seven being secondary isolates. Mutations in rdxA, 23S rRNA and gyrA genes were associated with resistance to metronidazole, clarithromycin and levofloxacin, respectively. Conclusion: The high level of resistance to metronidazole, clarithromycin and levofloxacin seen in H. pylori isolates in our setting warrants the need for continuous surveillance and highlights caution in use of antibiotics generally used as first-line therapy in H. pylori eradication regimen.

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KW - Point mutation

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