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Journal List > Korean J Gastroenterol > v.58(2) > 1006906

Kim, Kim, Park, Jo, Shin, Lee, Park, Hwang, Kim, Jeong, Lee, Nam, Kim, Lee, Jung, and Song: Primary Antibiotic Resistance of Helicobacter pylori Strains and Eradication Rate according to Gastroduodenal Disease in Korea

Abstract

Background/Aims

This study was performed to evaluate whether the prevalence rates of primary antibiotic resistance in Helicobacter pylori (H. pylori) isolates and the eradication rate of H. pylori could be different between cancer and non-cancer patients.

Methods

H. pylori were isolated from gastric mucosal biopsy specimens obtained from 269 Koreans, who did not have any eradication therapy history and were diagnosed as one of the following diseases; chronic gastritis, benign gastric ulcer, duodenal ulcer or gastric cancer. The susceptibilities of the H. pylori isolates to amoxicillin, clarithromycin, metronidazole, tetracycline, azithromycin, ciprofloxacin, levofloxacin and moxifloxacin were examined with the agar dilution method. In addition, eradication rate of H. pylori was evaluated.

Results

There was no significant difference in the primary antibiotic resistance to above eight antibiotics among chronic gastritis, peptic ulcer disease and gastric cancer. Furthermore there was no difference of antibiotic resistance between cancer and non-cancer patients, and there was no difference of eradication rate of H. pylori according to disease.

Conclusions

Primary antibiotic resistance and H. pylori eradication rate were not different between cancer and non-cancer patients.

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References

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kjg-58-74f1.tif
Fig. 1.
Minimal inhibitory concentration (MIC) distributions of antibiotics for H. pylori: MICs of amoxicillin (A), clarithromycin (B), metronidazole (C), tetracycline (D), azithromycin (E), ciprofloxacin (F), levofloxacin (G) and moxifloxacin (H). The dotted line indicates the break point of each antibiotic.
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kjg-58-74f2.tif
Fig. 2.
Eradication rate of H. pylori in 3 different diseases. There was no significant difference among chronic gastritis, peptic ulcer disease and stomach cancer.
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Table 1.
Patient Characteristics
  Chronic gastritis Peptic ulcer disease Stomach cancer p-value
No. (%) Mean age (±SD, yr) 87 (32.3) 57.1±10.3 47 (17.5) 51.2±13.7 135 (50.2) 58.3±12.2 0.002 a
Gender (male/female, male %) 46/41 (52.9) 31/16 (66.0) 87/48 (64.6) 0.168 b
Cigarette smoking (non/current/past, %) 52.9/20.0/27.1 38.3/42.6/19.1 44.7/22.7/32.6 0.031 b
Alcohol consumption (non/current/past, %) 48.9/43.0/8.1 34.0/49.0/17.0 43.9/40.9/15.2 0.330 b
Strain No. 3.26 3.11 2.79 0.984 a

a ANOVA test,

b χ2 test.

Table 2.
Prevalence of Primary Antibiotic Resistance of H. pylori Isolates in Stomach Cancer and Non-cancer Groups
  Non-cancer (n=134, %) Cancer (n=135, %) Total (n=269, %) p-value a
Amoxicillin 13 (9.7) 24 (17.8) 37 (13.8) 0.054
Clarithromycin 34 (25.4) 34 (25.2) 68 (25.3) 0.972
Metronidazole 40 (29.9) 33 (24.4) 73 (27.1) 0.319
Tetracycline 13 (9.7) 13 (9.6) 26 (9.7) 0.984
Azithromycin 34 (25.4) 36 (26.7) 70 (26.0) 0.809
Ciprofloxacin 39 (29.1) 45 (33.3) 84 (31.2) 0.454
Levofloxacin 31 (25.9) 38 (28.1) 69 (25.7) 0.346
Moxifloxacin 31 (25.9) 38 (28.1) 69 (25.7) 0.346

a χ2 test. Resistant breakpoints of MIC were defined as 0.5 μ g/ mL for amoxicillin, 1.0 μ g/mL for clarithromycin, 8.0 μ g/mL for metronidazole, 4.0 μ g/mL for tetracycline, 1.0 μ g/mL for azithromycin, ciprofloxacin, levofloxacin and moxifloxacin. Values represent percent numbers (patients infected with resistant H. pylori/ total subjects).

Table 3.
Prevalence of Primary Antibiotic Resistance of H. pylori Isolates according to Disease
  Chronic gastritis (n=87, %) Peptic ulcer disease (n=47, %) Stomach cancer (n=135, %) Total (n=269, %) p-value a
Amoxicillin 7 (8.0) 6 (12.8) 24 (17.8) 37 (13.8) 0.118
Clarithromycin 24 (27.6) 10 (21.3) 34 (25.2) 68 (25.3) 0.725
Metronidazole 28 (32.2) 12 (25.5) 33 (24.4) 73 (27.1) 0.432
Tetracycline 10 (11.5) 3 (6.4) 13 (9.6) 26 (9.7) 0.633
Azithromycin 24 (27.6) 10 (21.3) 36 (26.7) 70 (26.0) 0.708
Ciprofloxacin 27 (31.0) 12 (25.5) 45 (33.3) 84 (31.2) 0.610
Levofloxacin 25 (28.7) 6 (12.8) 38 (28.1) 69 (25.7) 0.083
Moxifloxacin 25 (28.7) 6 (12.8) 38 (28.1) 69 (25.7) 0.083

a χ2 test. Resistant breakpoints of MIC were defined as 0.5 μ g/mL for amoxicillin, 1.0 μ g/mL for clarithromycin, 8.0 μ g/mL for metronidazole, 4.0 μ g/mL for tetracycline, 1.0 μ g/mL for azithromycin, ciprofloxacin, levofloxacin and moxifloxacin. Values represent percent numbers (patients infected with resistant H. pylori/total subjects).

Table 4.
Prevalence of Multidrug Resistant H. pylori in Stomach Cancer and Non-cancer Groups
  Non-cancer (n=134) Cancer (n=135) Total (n=269) p-value
2 or more antibiotics (n, %) 3 or more antibiotics (n, %) 37 (27.6) 20 (14.9) 43 (31.9) 25 (18.5) 80 (29.7) 45 (16.7) 0.447 a 0.430a

a χ2 test. Amoxicillin, clarithromycin, metronidazole, tetracycline, ciprofloxacin resistance were examined.

Table 5.
Difference in Antibiotics Resistance Pattern in One Patient
No. of H. pylori isolates No. of patients One kind, n (%) Two kinds, n (%) Three kinds, n (%) Four kinds, n (%)
1 94   .    
2 55 45 (81.8) 10 (18.2) .  
3 40 20 (50.0) 19 (47.5) 1 (2.5) .
4 20 11 (55.0) 6 (30.0) 3 (15.0)  
5 23 9 (39.1) 9 (39.1) 5 (21.8)  
6 11 8 (72.7) 2 (18.2) 1 (9.1)  
7 9 6 (66.7) 1 (11.1) 2 (22.2)  
8 6 4 (66.6) 1 (16.7) 1 (16.7)  
9 6 2 (33.3) 3 (50.0) 1 (16.7)  
10 5 2 (40.0) 2 (40.0) 0 1 (20.0)
Total 269 107/175 (61.1) 53/175 (30.3)    
Table 6.
Factors Affecting H. pylori Eradication
  Success Failure p-value
n (%) 107 (89.2) 13 (10.8)  
Mean age±SD (yr) 53.5±11.6 57.0±9.2 0.303 a
Gender (male/female) 60/47 9/4 0.365 b
Clinical diagnosis (n, %)     0.215 c
Chronic gastritis 49 (45.8) 4 (30.8)  
 Peptic ulcer disease 34 (31.8) 3 (23.1)  
 Stomach cancer 24 (22.4) 6 (46.2)  
 Cigarette smoking (n, %) 57 (54.3) 8 (55.1) 0.272 b
 Alcohol consumption (n, %) 62 (59.0) 11 (31.2) 0.195 b
Eradication regimen     0.163 c
 PAC (n, %) 33 (33.3) 6 (60.0)  
 NAC (n, %) 66 (66.7) 4 (40.0)  
Antibiotic resistance (+)      
 Amoxicillin (n, %) 8 (7.5) 1 (7.7) 1.000 c
 Clarithromycin (n, %) 20 (18.7) 4 (16.7) 0.290 c
 Metronidazole (n, %) 29 (27.1) 2 (15.4) 0.511 c
 Tetracycline (n, %) 9 (8.4) 0 0.595 c
 Ciprofloxacin (n, %) 21 (27.1) 4 (30.8) 0.467 c

PAC, pantoprazole, amoxicillin and clarithromycin; NAC, esomeprazole, amoxicillin and clarithromycin.

a Student's t-test.

b χ2 test.

c Fisher's exact test.

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Nayoung Kim
https://orcid.org/http://orcid.org/0000-0002-9397-0406

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