Molecular Detection of Clarithromycin and Fluoroquinolones Resistance in Helicobacter Pylori Infection, Directly Applied to Gastric Biopsies, in an Urban Brazilian Population

Martins, Gustavo Luís Mamoré; Sanches, Bruno Squárcio Fernandes; Moretzsohn, Luciana Dias; Lima, Kauana Santos de; Cota, Bianca Della Croce Vieira; Coelho, Luiz Gonzaga Vaz

doi:10.1590/s0004-28032016000200012

Cited by 12 publications

(9 citation statements)

References 30 publications

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“…A study carried out in North-Eastern Brazil reported a primary resistance rate of 16.5% using phenotypic and genotypic methods[23]. The primary resistance rate to fluoroquinolones has ranged from 11% (genotypic method)[30] to 23% (phenotypic method) in South-Eastern Brazil[31]. The differences between the rates found in previous unicentric studies and in the present work may be attributed to differences in sample size, presence of heteroresistance[32], and overall differences in the history of previous antimicrobial consumption in the studied regions[33].…”

Section: Discussionmentioning

confidence: 99%

Detection ofHelicobacter pyloriresistance to clarithromycin and fluoroquinolones in Brazil: A national survey

Sanches¹,

Martins²,

Lima³

et al. 2016

WJG

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AIMTo evaluate bacterial resistance to clarithromycin and fluoroquinolones in Brazil using molecular methods.METHODSThe 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 GenoType HelicoDR (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.RESULTSClarithromycin 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 A2147G mutation was present in 90.4% (75/83), A2146G in 16.9% (14/83) and A2146C in 3.6% (3/83) of clarithromycin-resistant patients. In 10.8% (9/83) of clarithromycin-resistant samples, more than 01 mutation in the 23S rRNA gene was noticed. In fluoroquinolone-resistant samples, 37.9% (25/66) showed mutations not specified by the GenoType HelicoDR test. D91N mutation was observed in 34.8% (23/66), D91G in 18.1% (12/66), N87K in 16.6% (11/66) and D91Y in 13.6% (9/66) of cases. Among fluoroquinolone-resistant samples, 37.9% (25/66) showed mutations not specified by the GenoType HelicoDR test.CONCLUSIONThe H. pylori clarithromycin resistance rate in Brazil is at the borderline (15%-20%) for applying the standard triple therapy. The fluoroquinolone resistance rate (13.5%) is equally concerning.

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Section: Discussionmentioning

confidence: 99%

Detection ofHelicobacter pyloriresistance to clarithromycin and fluoroquinolones in Brazil: A national survey

Sanches¹,

Martins²,

Lima³

et al. 2016

WJG

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“…The results indicated that the rate of primary resistance was 16.5% in Recife (2010) (336) , 8% in São Paulo, state of São Paulo (337) , 2.5% in Marília, state of São Paulo (2013) (338) , 13% in Porto Alegre, state of Rio Grande do Sul (2014) (339) , 12.5% in Belo Horizonte, state of Minas Gerais (2016) (240) , and 16.9% in a national multicenter study (2016) (341) . For fluoroquinolones, the observed rates were 23% in São Paulo (337) , 5% in Porto Alegre (339) , 11.1% in Belo Horizonte (340) , and 13.4% at the national level (341) . With regard to resistance to metronidazole, an analysis of seven national studies confirmed the previous results, indicating consistently high rates (approximately 54%) (342) .…”

Section: Level Of Evidence: 2cmentioning

confidence: 96%

Ivth Brazilian Consensus Conference on Helicobacter Pylori Infection

Coelho

Marinho

Genta

et al. 2018

Arq. Gastroenterol.

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Significant progress has been obtained since the III Brazilian Consensus Conference on H. pylori infection held in 2012, in Bento Gonçalves, Brazil, and justify a fourth meeting to establish updated guidelines on the current management of H. pylori infection. Therefore, the Núcleo Brasileiro para Estudo do Helicobacter pylori e Microbiota (NBEHPM), association linked to Brazilian Federation of Gastroenterology (FBG) held its fourth meeting again in Bento Gonçalves, RS, Brazil, on August 25-27, 2017. Twenty-six delegates, including gastroenterologists, endoscopists, and pathologists from the five regions of Brazil as well as one international guest from the United States, participated in the meeting. The participants were invited based on their knowledge and contribution to the study of H. pylori infection. The meeting sought to review different aspects of treatment for infection; establish a correlation between infection, dyspepsia, intestinal microbiota changes, and other disorders with a special emphasis on gastric cancer; and reassess the epidemiological and diagnostic aspects of H. pylori infection. Participants were allocated into four groups as follows: 1) Epidemiology and Diagnosis, 2) Dyspepsia, intestinal microbiota and other afections, 3) Gastric Cancer, and, 4) Treatment. Before the consensus meeting, participants received a topic to be discussed and prepared a document containing a recent literature review and statements that should be discussed and eventually modified during the face-to-face meeting. All statements were evaluated in two rounds of voting. Initially, each participant discussed the document and statements with his group for possible modifications and voting. Subsequently, during a second voting in a plenary session in the presence of all participants, the statements were voted upon and eventually modified. The participants could vote using five alternatives: 1) strongly agree; 2) partially agree; 3) undecided; 4) disagree; and 5) strongly disagree. The adopted consensus index was that 80% of the participants responded that they strongly or partially agreed with each statement. The recommendations reported are intended to provide the most current and relevant evidences to management of H. pylori infection in adult population in Brazil.

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“…Existem várias explicações para a diminuição da eficácia da tripla terapia como a não adesão ao tratamento, alta acidez gástrica, alta carga bacteriana e virulência das cepas bacterianas, mas o mais importante é o aumento da resistência do H. pylori à claritromicina 18 . Apesar deste fato, um estudo brasileiro realizou teste molecular para avaliar a resistência a claritromicina associada ao metronidazol e sugere que ainda sejam usadas essas medicações tanto para primeira como para segunda escolha de tratamento 18 .…”

Section: Medicinaunclassified