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

• Published in: Infection and drug resistance Vol. 12; pp. 3051 - 3061
• Main Authors: Hanafiah, Alfizah, Binmaeil, Hasyanee, Raja Ali, Raja Affendi, Mohamed Rose, Isa, Lopes, Bruno S
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.09.2019; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Antibacterial agents; Antibiotic resistance; Antibiotics; Antimicrobial agents; Antiprotozoan agents; Biopsy; Clarithromycin; Disease susceptibility; Drug resistance; Endoscopy; Epidemiology; Eradication; Failure; Gene mutation; Genes; Health aspects; Helicobacter infections; Helicobacter pylori; Immunology; Infection; Infections; Laboratories; Levofloxacin; Medical centers; Medical research; Medicine; Metronidazole; Microbial drug resistance; Mixed infection; Multidrug resistance; Mutation; Original Research; Patient compliance; Patients; point mutation; RNA; RNA polymerase; rRNA; rRNA 23S; Tetracyclines; United Kingdom; Malaysia; United Kingdom > UK; Kuala Lumpur Malaysia; metronidazole; clarithromycin; Helicobacter pylori; antibiotic resistance; levofloxacin; point mutation
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/idr.s219069

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 infection. This study determined and characterized primary and secondary resistances in in Malaysia. 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. 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 , 23S rRNA and genes were associated with resistance to metronidazole, clarithromycin and levofloxacin, respectively. The high level of resistance to metronidazole, clarithromycin and levofloxacin seen in isolates in our setting warrants the need for continuous surveillance and highlights caution in use of antibiotics generally used as first-line therapy in eradication regimen.