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

• Main Authors: Hanafiah A, Binmaeil H, Raja Ali RA, Mohamed Rose I, Lopes BS
• Format: Article
• Language: English
• Published: Dove Medical Press 2019-09-01
• Series: Infection and Drug Resistance
• Subjects: Helicobacter pylori; antibiotic resistance; clarithromycin; metronidazole; levofloxacin; point mutation
• Online Access: https://www.dovepress.com/molecular-characterization-and-prevalence-of-antibiotic-resistance-in--peer-reviewed-article-IDR

Alfizah Hanafiah,1 Hasyanee Binmaeil,1 Raja Affendi Raja Ali,2 Isa Mohamed Rose,3 Bruno S Lopes4 1Department of Medical Microbiology and Immunology; 2Department of Medicine; 3Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia; 4Department of Medical Microbiology, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UKCorrespondence: Alfizah HanafiahDepartment of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 16th Floor, Preclinical Building, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, MalaysiaTel [phone]Fax [phone]Email [e-mail] S LopesDepartment of Medical Microbiology, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, 0:025 Polwarth Building, Aberdeen AB25 2ZD, UKEmail [e-mail] 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.Keywords: Helicobacter pylori, antibiotic resistance, clarithromycin, metronidazole, levofloxacin, point mutation