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Detection of Helicobacter pylori resistance to clarithromycin and fluoroquinolones in Brazil:A national survey

World Journal of Gastroenterology 2016年第33期22卷 7587-7594页

作者： Bruno Squarcio Sanches Gustavo Miranda Martins Karine Lima Bianca Cota Luciana Dias Moretzsohn Laercio Tenorio Ribeiro Helenice P Breyer Ismael Maguilnik Aline Bessa Maia Joffre Rezende-Filho Ana Carolina Meira Henrique Pinto Edson Alves Ramiro Mascarenhas Raissa Passos Julia Duarte de Souza Osmar Reni Trindade Luiz Gonzaga Coelho Instituto Alfa de Gastroenterologia Hospital das ClínicasUniversidade Federal de Minas Gerais Unigastro e Clínica Santa Fé Hospital de Clínicas Universidade Federal do Rio Grande do Sul Fundacao Hospital Adriano Jorge Hospital das Clínicas Universidade Federal de Goiás Hospital Geral Roberto Santos

AIM To evaluate bacterial resistance to clarithromycin and fluoroquinolones in Brazil using molecular methods.METHODS The primary antibiotic resistance rates of Helicobacter pylori(H. pylori) were determined from November 2012 to March 2015 in the Southern,South-Eastern,Northern,North-Eastern,and Central-Western regions of Brazil. Four hundred ninety H. pylori patients [66% female,mean age 43 years(range: 18-79)] who had never been previously treated for this infection were enrolled. All patients underwent gastroscopy with antrum and corpus biopsies and molecular testing using Geno Type Helico DR(Hain Life Science,Germany). This test was performed to detect the presence of H. pylori and to identify point mutations in the genes responsible for clarithromycin and fluoroquinolone resistance. The molecular procedure was divided into three steps: DNA extraction from the biopsies,multiplex amplification,and reverse hybridization. RESULTS Clarithromycin resistance was found in 83(16.9%) patients,and fluoroquinolone resistance was found in 66(13.5%) patients. There was no statistical difference in resistance to either clarithromycin or fluoroquinolones(P = 0.55 and P = 0.06,respectively) among the different regions of Brazil. Dual resistance to clarithromycin and fluoroquinolones was found in 4.3%(21/490) of patients. The A2147 G mutation was present in 90.4%(75/83),A2146 G in 16.9%(14/83) and A2146 C in 3.6%(3/83) of clarithromycin-resistant patients. In 10.8%(9/83) of clarithromycin-resistant samples,more than 01 mutation in the 23 S r RNA gene was noticed. In fluoroquinolone-resistant samples,37.9%(25/66) showed mutations not specified by the Geno Type Helico DR test. D91 N mutation was observed in 34.8%(23/66),D91 G in 18.1%(12/66),N87 K in 16.6%(11/66) and D91 Y in 13.6%(9/66) of cases. Among fluoroquinolone-resistant samples,37.9%(25/66) showed mutations not specified by the Geno Type Helico DR test. CONCLUSION The H. pylori clarithromycin resistance rate in Brazil is at the borderline(15%-20%) for applying the sta

关键词： Helicobacter pylori Microbial drug resistance Clarithromycin Fluoroquinolones molecular diagnostic techniques

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