Study on Clarithromycin and Levofloxacin Resistance Mutations in Helicobacter pylori Bacteria among Patients with Gastric Inflammation at Bac Lieu General Hospital

Van Truong Huynh; Doan Hau Tran; Tuan Anh Nguyen; Minh Tu Hoang; Gia Bao Huynh

Van Truong Huynh
Doan Hau Tran
Tuan Anh Nguyen
Minh Tu Hoang
Gia Bao Huynh

Keywords: H. pylori, clarithromycin, levofloxacin, antibiotic resistance, gene sequencing

Abstract

Background: Helicobacter pylori infection in Vietnam accounts for 70-90% of the population. As the number one cause of inflammation, ulcers and stomach cancer, H. pylori bacteria can be effectively treated with antibiotics. However, drug resistance of H. pylori is a matter of great concern. Objectives of the study: To determine the rate of 23S rRNA and gyrA gene mutations resistant to clarithromycin and levofloxacin of H. pylori bacteria in gastritis patients and some related factors. Subjects and methods: A cross-sectional descriptive study on H. pylori-positive gastritis patients at Bac Lieu General Hospital. Results: The rate of mutations resistant to clarithromycin is 85.7% and levofloxacin is 60.3%. For clarithromycin, the mutation at position T2182C accounts for the highest rate (80.9%), A2143G (57.2%) and the lowest one is A2142G (1.6%). For levofloxacin, two common sites are amino acids 87 and 91, the rate of levofloxacin antibiotic resistance mutations for positions N87K, T87I, D91N, D91Y and D91G is 31.7%, 3,2%, 12.7%, 1.6% and 14.3% respectively. In particular, there is a newly discovered mutation capable of causing levofloxacin resistance – H (Histidine) at position 87H with the rate 1.6%. Up to 24 H. pylori samples have both levofloxacin and clarithromycin resistance mutations with the rate of 38.1%. Conclusion: The study has determined the rate of resistance mutations to the antibiotics clarithromycin and levofloxacin currently used to treat H. pylori, the mutation rate in the study is really remarkable and in need of attention in treatment.

References

Cui, R., Song, Z., Suo, B., Tian, X., Xue, Y., Meng, L., ... & Zhou, L. (2021). Correlation analysis among genotype resistance, phenotype resistance and eradication effect of Helicobacter pylori. Infection and Drug Resistance, 14, 1747-1756.
Dao, T. (2021). Application of REALTIME-PCR technique to detect clarithromycin resistance mutations of Helicobacter pylori in gastritis patients at Tien Giang Central General Hospital in 2020-2021. Master thesis in medical testing, Can Tho University of Medicine and Pharmacy.
Hanafiah, A., Binmaeil, H., Raja Ali, R. A., et al. (2019). Molecular characterization and prevalence of antibiotic resistance in Helicobacter pylori isolates in Kuala Lumpur, Malaysia. Infect Drug Resist, 12, 3051-3061.
Lok, C. H., Zhu, D., Wang, J., Ren, Y. T., Jiang, X., Li, S. J., & Zhao, X. Y. (2020). Phenotype and molecular detection of clarithromycin and levofloxacin resistance in Helicobacter pylori clinical isolates in Beijing. Infection and Drug Resistance, 13, 2145-2153.
Megraud, F. et al. (2013). Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut, 62(1), 34-42.
Murakami, K. et al. (2009). Sitafloxacin activity against Helicobacter pylori isolates, including those with gyrA mutations. Antimicrob Agents Chemother, 53(7), 3097-3099.
Nguyen, T. N. (2021). Research on the detection of Helicobacter pylori bacteria in saliva by REAL-TIME PCR technique on patients with gastritis-duodenitis disease and inflammation at the Hospital of Can Tho University of Medicine and Pharmacy in 2020-2021. Master thesis in medical testing, Can Tho University of Medicine and Pharmacy.
Nguyen, V. K. (2021). Application of Etest techniques to determine drug resistance and gene sequencing techniques to detect levofloxacin resistance mutations of Helicobacter pylori bacteria in gastritis patients at Tien Giang Central General Hospital in 2020-2021. Master thesis in medical testing, Can Tho University of Medicine and Pharmacy.
Nhu, L. T. T., Nguyen, V. L., Tran, V. D., Tran, N. A., & Nguyen, V. T. (2022). Evaluation of the Antibiotic Resistance Rate of Helicobacter pylori in Peptic Ulcer Patients in Tien Giang Central General Hospital, Tien Giang Province, Vietnam. Open Access Macedonian Journal of Medical Sciences, 10(B), 1835–1839. https://doi.org/10.3889/oamjms.2022.10216
Park, J. Y., Shin, T. S., Kim, J. H., Yoon, H. J., Kim, B. J., & Kim, J. G. (2020). The prevalence of multidrug resistance of Helicobacter pylori and its impact on eradication in Korea from 2017 to 2019: A single-center study. Antibiotics, 9(10), 646.
Redondo, J. J. et al. (2018). A novel RT-PCR for the detection of Helicobacter pylori and identification of clarithromycin resistance mediated by mutations in the 23S rRNA gene. Diagn Microbiol Infect Dis, 90(1), 1-6.
Tran, T. T., Tran, A. M., & Nguyen, T. A. (2017). Research on the rate of clarithromycin and levofloxacin resistance mutations of Helicobacter pylori by gene sequencing. Vietnam Journal of Gastroenterology, 9(49), 3074-3082.
Venneman, K. et al. (2018). The epidemiology of Helicobacter pylori infection in Europe and the impact of lifestyle on its natural evolution toward stomach cancer after infection: A systematic review. Helicobacter, 23(3), e12483.