Information regarding Helicobacter pylori antibiotic resistance in Indonesia was previously inadequate. We assessed antibiotic susceptibility for H. pylori in Indonesia, and determined the association between virulence genes or genetic mutations and antibiotic resistance. We recruited 849 dyspeptic patients who underwent endoscopy in 11 cities in Indonesia. E-test was used to determine the minimum inhibitory concentration of five antibiotics. PCR-based sequencing assessed mutations in 23S rRNA, rdxA, gyrA, gyrB, and virulence genes. Next generation sequencing was used to obtain full-length sequences of 23S rRNA, infB, and rpl22. We cultured 77 strains and identified 9.1% with clarithromycin resistance. Low prevalence was also found for amoxicillin and tetracycline resistance (5.2% and 2.6%, respectively). In contrast, high resistance rates to metronidazole (46.7%) and levofloxacin (31.2%) were demonstrated. Strains isolated from Sumatera Island had significantly higher metronidazole resistance than those from other locations. Metronidazole resistant strains had highly distributed rdxA amino acid substitutions and the 23S rRNA A2143G mutation was associated with clarithromycin resistance (42.9%). However, one strain with the highest MIC value had a novel mutation in rpl22 without an A2143G mutation. Mutation at Asn-87 and/or Asp-91 of gyrA was associated with levofloxacin-resistance and was related to gyrB mutations. In conclusions, although this is a pilot study for a larger survey, our current data show that Indonesian strains had the high prevalence of metronidazole and levofloxacin resistance with low prevalence of clarithromycin, amoxicillin, and tetracycline resistance. Nevertheless, clarithromycin- or metronidazole-based triple therapy should be administered with caution in some regions of Indonesia.

SUMMARY:Variation by country in urinary tract infection (UTI)-causative bacteria is partly due to the differences in the use of antibiotics. We compared their frequencies and antibiotic susceptibilities in the treatment of patients with UTI from 2 cities, Kobe, Japan, and Surabaya, Indonesia. We retrospectively analyzed 1,804 urine samples collected from patients with UTI in 2014 (1,251 collected in 11 months at Kobe University Hospital in Kobe and 544 collected in 2 months at Dr. Soetomo Hospital in Surabaya). Surabaya data were divided into adult and pediatric patients because a substantial number of specimens from pediatric-patients had been collected. The results indicated that Escherichia coli was the most common uropathogen (24.1 in Kobe and 39.3 in Surabaya) and was significantly resistant to ampicillin and substantially to first-and third-generation cephalosporins in Surabaya adults but not in Kobe adults (p ＜ 0.01). Enterococcus faecalis was often isolated in Kobe (14.0 ), but not in Surabaya (5.3 ). Klebsiella spp. were isolated at a higher rate in Surabaya pediatric patients (20.3 ) than in Surabaya adults (13.6 ) and Kobe adults (6.6 ). The antibiotic susceptibilities of the isolates form Surabaya isolates tended to be lower than the ones from Kobe. Extended-spectrum β-lactamaseproducing Gram-negative bacteria were detected at a significantly higher rate in Surabaya than in Kobe (p ＜ 0.001). These results showed that the antimicrobial resistance patterns of UTI-causative bacteria are highly variable among 2 countries, and the continuous surveillance of trends in antibiotic resistance patterns of uropathogens is necessary for the future revision of antibiotic use.

Objectives To explore the occurrence and characterization of carbapenemase‐producing pathogens among carbapenem‐resistant Gram‐negative bacilli isolated from hospitalized patients with urinary tract infection in Indonesia. Methods This was a study promoted by the Japanese–Indonesian collaborative research program in the Japan Initiative for Global Research Network on Infectious Diseases. Bacterial pathogens were prospectively isolated from urine specimens of hospitalized urinary tract infection patients at Dr. Soetomo Hospital (Surabaya, Indonesia). All Gram‐negative bacteria resistant to third‐generation cephalosporin or carbapenem were included in this study. Carbapenemase genes were investigated for phenotype and genotype. Results In total, 1082 Gram‐negative bacilli were isolated, of which 116 strains were resistant to imipenem or meropenem (carbapenem‐resistant Gram‐negative bacilli), and 22 strains were carbapenemase‐producing Gram‐negative bacilli. Carbapenemase‐producing Gram‐negative bacilli consisted of Acinetobacter baumannii (n = 4), Pseudomonas aeruginosa (n = 4), Klebsiella pneumoniae (n = 5), Providencia rettgeri (n = 4) and five others. The carbapenemase‐producing Gram‐negative bacilli included NDM‐1 (n = 18, 81.8%, in Enterobacteriaceae and Acinetobacter spp.) and IMP‐7 (n = 4, 18.2%, all in P. aeruginosa). Among carbapenem‐resistant Gram‐negative bacilli, all four P. aeruginosa were sensitive to colistin, and all six Acinetobacter spp. were sensitive to minocycline, colistin and tigecycline. Of those patients harboring carbapenemase‐producing Gram‐negative bacilli, 12 (54.5%) were seriously ill at the time of admission, with longer hospital stays and three deaths (13.6% mortality rate). Conclusions Urinary tract infection‐causing carbapenem‐resistant Gram‐negative bacilli are widely disseminated in Indonesia. The NDM‐1 phenotype seems to be dominant, and it can be treated with colistin and tigecycline in most cases. Most patients harboring carbapenemase‐producing Gram‐negative bacilli are seriously ill, have a bad prognosis, with a longer hospital stay and a significant mortality rate.

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In order to increase our knowledge of the epidemiology for our patient population, we retrospectively analyzed the data obtained from stool samples received at Tropical Disease Research Center, Airlangga University during a five year period. Isolation frequency of enteropathogens from diarrheal stools from 1993 to 1997 were examined in Surabaya, Indonesia. A total of 1,477 hospitalized pediatric patients under 2 years of age with acute diarrhea were enrolled. Bacterial enteropathogens other than Campylobacter jejuni and Clostridium difficile were positive cumulatively in 1,086 cases out of 1,477 (73.5%) , and the annual isolation frequency ranged from 61.1% to 82.4%. Rotavirus was detected cumulatively in 408 cases out of 1,184 examined (34.5%) , and 210 cases of 408 (51.5%) were co-infected with diarrheagenic Escherichia coli. Generally, diarrheagenic E. coli were dominant isolates (53.8%) while Vibrio cholerae 01, Aeromonas hydrophila, Salmonella spp. and Shigella spp. were also isolated from the patients with lower frequencies.