Abstract
Purpose
The antimicrobial resistance of Helicobacter pylori is one of the critical factors in failure of eradication therapy. The purpose of this study was to evaluate antimicrobial resistance of H. pylori in Korean children.
Methods
Gastric mucosal specimens for H. pylori were obtained from children with dyspepsia who were cared for at Asan Medical Center Children's Hospital in Seoul, Korea between 2003 and 2009. Antimicrobial resistance tests were performed using the disk diffusion method for clarithromycin and amoxicillin and the E-test for metronidazole and tetracycline. Most children with H. pylori infections were treated using triple therapies.
Results
Thirty-three children had positive H. pylori cultures, although a resistance test was only performed in 28 patients. Resistant strains were found in 9 children (32.1%). The resistance rates to clarithromycin and metronidazole were 25% and 17.8%, respectively. There was no resistance to amoxicillin or tetracycline. The resistance rates decreased from 44.4% (2003~2006) to 26.3% (2006~2009) during the study period.
Conclusion
Korean children demonstrated relatively high antimicrobial resistance to H. pylori in this study. However, there was a temporarily decreasing trend during the study period. A larger multi-regional study may be needed to determine the optimal antimicrobial treatment for pediatric patients infected with H. pylori.
Figures and Tables
Table 3
Amoxicillin and tetracyclin have no resistant strain, CLR: clarithromycin, MET: metronidazole, -: susceptible, +: resistant, OAC: omeprazole+amoxicillin+clarithromycin, BAM: bismuth subsalicylate+amoxicillin+metronidazole, OAM: omeprazole+amoxicillin+metronidazole, BOAC: bismuth subsalicylate+omeprazole+amoxicillin+clarithromycin, BOAM: bismuth subsalicylate+omeprazole+amoxicillin+metronidazole, BOMC: bismuth subsalicylate+omeprazole+metronidazole+clarithromycin, OAQ: omeprazole+amoxicillin+moxifloxacin.
References
1. NIH Consensus Conference. Helicobacter pylori in peptic ulcer disease. NIH consensus development panel on Helicobacter pylori in peptic ulcer disease. JAMA. 1994. 272:65–69.
2. Dohil R, Hassall E, Jevon G, Dimmick J. Gastritis and gastropathy of childhood. J Pediatr Gastroenterol Nutr. 1999. 29:378–394.
3. Taylor DN, Blaser MJ. The epidemiology of Helicobacter pylori infection. Epidemiol Rev. 1991. 13:42–59.
4. Gottrand F, Turck D, Vincent P. Helicobacter pylori infection in early infancy. Lancet. 1992. 340:495.
5. Rhee HS, Kim HS, Jang JJ, Seo JK. Endoscopic and pathologic analysis of pediatric Helicobacter pylori gastritis. Korean J Gastroenterol. 2000. 36:10–19.
6. Drumm B, Sherman P, Cutz E, Karmali M. Association of Campylobacter pylori on the gastric mucosa with antral gastritis in children. N Engl J Med. 1987. 316:1557–1561.
7. Mitchell HM, Bohane TD, Tobias V, Bullpitt P, Daskalopoulos G, Carrick J, et al. Helicobacter pylori infection in children: potential clues to pathogenesis. J Pediatr Gastroenterol Nutr. 1993. 16:120–125.
8. Gottrand F, Cullu F, Turck D, Vincent P, Michaud L, Husson MO, et al. Normal gastric histology in Helicobacter pylori-infected children. J Pediatr Gastroenterol Nutr. 1997. 25:74–78.
9. Langenberg W, Rauws EA, Houthoff HJ, Oudbier JH, van Bohemen CG, Tytgat GN, et al. Follow-up study of individuals with untreated Campylobacter pylori-associated gastritis and of noninfected persons with non-ulcer dyspepsia. J Infect Dis. 1988. 157:1245–1249.
10. Choe YH. Helicobacter pylori infection in children: recommendations for diagnosis and treatment. Korean J Pediatr. 2004. 47:235–239.
11. Gold BD, Colletti RB, Abbott M, Czinn SJ, Elitsur Y, Hassall E, et al. Helicobacter pylori infection in children: recommendations for diagnosis and treatment. J Pediatr Gastroenterol Nutr. 2000. 31:490–497.
12. Kim KM, Oh YL, Ko JS, Choe YH, Seo JK. Histopathology and expression of Ki-67 and cyclooxygenase-2 in childhood Helicobacter pylori gastritis. J Gastroenterol. 2004. 39:231–237.
13. Sung HS, Chung HJ, Kim MN, Lee GH. Clinical usefulness of antimicrobial susceptibility test for Helicobacter pylori. Korean J Lab Med. 2006. 26:179–184.
14. Sung HS, Kang JO, Lee MA, Lee JW, Lee HK, Lee MK, et al. Clarithromycin and amoxicillin susceptibility testing of Helicobacter pylori by disk diffusion method. Korean J Clin Microbiol. 2009. 12:30–36.
15. Malfertheiner P, Me' graud F, O'Morain C, Hungin AP, Jones R, Axon A, et al. Current concepts in the management of Helicobacter pylori infection-the Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther. 2002. 16:167–180.
16. Kim JG. Treatment of Helicobacter pylori infection. Korean J Gastroenterol. 2005. 46:172–180.
17. Lee JH, Kim HY, Park JK, Sim JH, Kim JW, Hwang JH, et al. Current effectiveness of Helicobacter pylori eradication treatment in primary care setting in Korea. Korean J Med. 2003. 65:422–425.
18. Murakami K, Nasu M. Drug sensitivity test for Helicobacter pylori. Nippon Rinsho. 2002. 60:Suppl 2. 350–353.
19. Osato MS. Antimicrobial susceptibility testing for Helicobacter pylori: sensitivity test results and their clinical relevance. Curr Pharm Des. 2000. 6:1545–1555.
20. Smaill F. Antibiotic susceptibility and resistance testing: an overview. Can J Gastroenterol. 2000. 14:871–875.
21. Kato S, Fujimura S, Udagawa H, Shimizu T, Maisawa S, Ozawa K, et al. Antibiotic resistance of Helicobacter pylori strains in Japanese children. J Clin Microbiol. 2002. 40:649–653.
22. National Committee for Clinical Laboratory Standard. Perfomance standards for antimicrobial susceptibility testing: informational supplement. NCCLS document M100-S9. 1999. Wayne (PA): NCCLS.
23. Kim ES, Kang JO, Han DS, Park PW, Par IK, Choi TY. Comparison of modified broth microdilution method, E test, and disk diffusion method for antimicrobial susceptibility testing of Helicobacter pylori. Korean J Clin Pathol. 1998. 18:559–564.
24. Kang JO, Han DS, Choi TY. Evaluation of four methods for antimicrobial susceptibility testing of Helicobacter pylori in routine practice. Korean J Clin Microbiol. 2005. 8:82–89.
25. Chung CH, Kim JJ, Kim YH, Rhee PL, Rhee JC, Graham DY, et al. Analysis of metronidazole, clarithromycin and tetracycline resistance of Helicobacter pylori isolates from Korea. Korean J Helicobacter Res Pract. 2002. 2:57–60.
26. Lee H, Kim JJ. Impact of metronidazole resistance on eradication rate for Helicobacter pylori. Korean J Gastroenterol. 2005. 46:142–145.
27. Lee HK, Chae HS, Kang JO, Lee MK, Sung HS, Kim MN, et al. Multicenter study for the frequency of 23S rRNA point mutations associated with clarithromycin resistance in Helicobacter pylori in Korea. Korean J Clin Microbiol. 2008. 11:84–89.
28. Kim JM. Antibiotics resistance of Helicobacter pylori isolated from Korean patients. Korean J Gastroenterol. 2006. 47:337–349.
29. Chung WC, Lee KM, Paik CN, Lee JR, Jung SH, Kim JD, et al. Inter-departmental differences in the eradication therapy for Helicobacter pylori infection: a single center study. Korean J Gastroenterol. 2009. 53:221–227.
30. Kim SJ, Kim JG, Jung K, Hong YH, Kim JH, Jung HR, et al. Antimicrobial resistance rate of Helicobacter pylori isolates and detection of mechanism of clarithromycin resistance. Korean J Med. 2001. 61:470–478.
31. Bang SY, Han DS, Eun CS, Kim JE, Ahn SB, Sohn JH, et al. Changing patterns of antibiotic resistance of Helicobacter pylori in patients with peptic ulcer disease. Korean J Gastroenterol. 2007. 50:356–362.
32. Agudo S, Alarcón T, Cibrelus L, Urruzuno P, Martínez MJ, López-Brea M. High percentage of clarithromycin and metronidazole resistance in Helicobacter pylori clinical isolates obtained from Spanish children. Rev Esp Quimioter. 2009. 22:88–92.
33. Wewer V, Kalach N. Helicobacter pylori infection in pediatrics. Helicobacter. 2003. 8:Suppl 1. 61–67.