A significant knowledge gap exists concerning the geographical distribution of nontuberculous mycobacteria (NTM) isolation worldwide.To provide a snapshot of NTM species distribution, global partners in the NTM-Network European Trials Group (NET) framework (www.ntm-net.org), a branch of the Tuberculosis Network European Trials Group (TB-NET), provided identification results of the total number of patients in 2008 in whom NTM were isolated from pulmonary samples. From these data, we visualised the relative distribution of the different NTM found per continent and per country.We received species identification data for 20 182 patients, from 62 laboratories in 30 countries across six continents. 91 different NTM species were isolated. Mycobacterium avium complex (MAC) bacteria predominated in most countries, followed by M. gordonae and M. xenopi. Important differences in geographical distribution of MAC species as well as M. xenopi, M. kansasii and rapid-growing mycobacteria were observed.This snapshot demonstrates that the species distribution among NTM isolates from pulmonary specimens in the year 2008 differed by continent and differed by country within these continents. These differences in species distribution may partly determine the frequency and manifestations of pulmonary NTM disease in each geographical location. @ERSpublications Species distribution among nontuberculous mycobacteria isolates from pulmonary specimens is geographically diverse

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Clarithromycin and metronidazole resistance was 29.1 and 23.9%, respectively, in 96 Helicobacter pylori strains obtained from pediatric patients. No resistance to amoxicillin was observed. Resistance according to patients' ages to clarithromycin and metronidazole was 45.4 and 18.2% in 22 patients from 4 to 8 years old, 30.2 and 20.7% in 53 patients from 9 to 13 years old, and 9.5 and 38.1% in 21 patients from 14 to 18 years old, respectively. The A2143G mutation was the most prevalent (82.1%) among clarithromycin-resistant strains.Helicobacter pylori is a gram-negative microaerophilic rod found in the human gastric mucosa associated with different digestive diseases, such as peptic ulcer, gastritis, and mucosaassociated lymphoid tissue lymphoma (7), and it is considered a risk factor in the development of gastric cancer (24). H. pylori infection is frequently acquired during childhood, and symptoms such as vomiting and epigastric or recurrent abdominal pain are associated with H. pylori infection (6).Amoxicillin, tetracycline, metronidazole, and clarithromycin are frequently used, combined with proton pump inhibitors or bismuth salts, for the treatment of H. pylori infections (22). However, side effects, poor compliance, and resistance to antibiotics are causes of treatment failure (4, 16). Resistance to metronidazole and clarithromycin is population dependent, and several studies suggest that clarithromycin resistance is higher in strains obtained from children than in those from adults (9).The aim of this study was to determine the rate of resistance to clarithromycin in H. pylori strains obtained from pediatric patients according to the age of the patients. Metronidazole and amoxicillin resistance was also studied. The mutation involved in clarithromycin resistance was detected by PCR-restriction fragment length polymorphism analysis.Ninety-six pediatric patients, aged from 4 to 18 years (mean age Ϯ standard deviation, 10.86 Ϯ 3.3 years), attending the Gastroenterology Unit at the Hospital del Niño Jesus during 1999 and 2000, were included in this study. Patients were referred for endoscopy due to different symptoms, with epigastric pain (74.2%), vomiting (33.3%), and recurrent abdominal pain (25.8%) being the most prevalent. Parents signed an informed consent form for the endoscopy, and the Ethical Committee supervised the study. Patients previously treated for H. pylori infections were not included. Strains were grouped according to the age of the patient at the time of endoscopy.Only culture-positive patients were included. H. pylori clinical isolates were obtained from gastric biopsy specimens according to standard procedures.Clarithromycin was obtained from Abbott Laboratories SA, Madrid, Spain, and metronidazole and amoxicillin were obtained from Sigma-Aldrich, Madrid, Spain. MICs were determined by an agar dilution technique with Mueller-Hinton agar plus 7% horse blood according to NCCLS recommendations (17). Plates with twofold dilutions of each antibiotic were inoculated with 1 to 2 l of 10 9 CFU/ml ...

The evolution of clarithromycin, metronidazole and amoxycillin resistance in 246 Spanish Helicobacter pylori clinical isolates, obtained from paediatric patients during a 9 year period, was determined by an agar dilution technique. Clarithromycin resistance (MIC 1 mg/L) was 2.27% (IC95 0.05-12.02) in 1991-1993, 20.98% (IC95 12.72-31.46) in 1994-1996 and 28.33% (IC95 20.48-37.28) in 1997-1999 (P < 0.01). Metronidazole resistance (MIC 8 mg/L) was 7.14% (IC95 1.49-19.48) in 1991-1993, 20.25% (IC95 12.04-30.79) in 1994-1996 and 43.90% (IC95 32.95-55.30) in 1997-1999 (P < 0.01). Amoxycillin resistance was not found (all strains showed MICs < 2 mg/L).

The aim of this study was to determine the frequency of resistance to amoxycillin, tetracycline, metronidazole and clarithromycin in 282 Helicobacter pylori clinical isolates from Spain and to evaluate the evolution of resistance over the five years of this study. The overall percentage of resistance was 19.9% for metronidazole and 3.5% for clarithromycin. Resistance to metronidazole rose from 9% in 1991 to 21.6% in 1995, although 33.3% resistance was found in 1993. Clarithromycin resistance was not detected in 1991 or 1992 and the rate was 4%, 3.4% and 4.4% in 1993, 1994 and 1995, respectively. No amoxycillin or tetracycline resistance was found.