Molecular diagnosis of Helicobacter pylori antibiotic resistance in the Taif region, Saudi Arabia

Abstract

Success in eradication of Helicobacter pylori is declining globally because H. pylori has developed resistance against most of the antibiotics proposed for eradication regimens, mainly through point mutations. The present study included 200 patients with dyspepsia attending Taif Hospital. Gastric biopsies were obtained during gastroscopy and subjected to rapid urease testing. Molecular methods were used to confirm diagnoses of H. pylori infection and to identify resistance gene variants of four antibiotics; namely, clarithromycin, metronidazole, fluoroquinolones and tetracycline (23S rRNA, gyrA, rdxA and 16S rRNA respectively). Of all investigated patients, Molecular diagnoses were made in 143 of all investigated patients; thus, the prevalence was .5%. The overall rate of resistance to clarithromycin among the H. pylori‐positive patients was high (39.9%) and the rate of resistance significantly greater (48.2%) among the secondary resistance group, secondary resistance being defined as resistance as a result of previous exposure to the relevant antibiotic. The rate of resistance to fluoroquinolones was considered moderate; the difference in rate of resistance between the primary and secondary resistance groups (8.4% and 9.5%, respectively) was not significant Also, there was a low prevalence of both primary and the secondary tetracycline resistance in the study cohort. In contrast, the prevalence of metronidazole resistance was considered high with no significant difference between the two resistance groups. H. pylori showed an increased prevalence of resistance to all four of the commonly used therapeutic agents. Thus, eradication therapy should be based on the regional results of susceptibility testing. Moreover, treatment tailored according to individually determined H. pylori susceptibility may be a reasonable future goal.

The increasing antimicrobial resistance of Helicobacter pylori in Iran: A systematic review and meta‐analysis

“…Compared to the data from Eastern Mediterranean, the resistance rate to clarithromycin was two times higher in our study (WPR 21%, 95% CI 16‐26) than was observed in Egypt (WPR 56%, 95% CI, 47‐64) and Pakistan (WPR 40%, 95% CI 32‐49) yet at the same level as that reported in Saudi Arabia (WPR 23%, 95% CI 15‐34) 13 ; however, the latest data from Saudi Arabia suggest there is an increasing trend toward resistance (39.9%) 83 . The highest resistance rate for metronidazole identified in our study (WPR 62%, 95% CI 57‐67) is in the line with data from Pakistan and Egypt (WPR 62%, 95% CI 51‐74 and WPR 63%, 95% CI 51‐73), and although slightly lower in Saudi Arabia (WPR 49%, 95% CI 37‐60), 13 the resistance is still high.…”

“…The limitation of our study is the inclusion of the overall resistance rates in the meta‐analyses which does not allows a distinction between primary and secondary resistance rates. As the data from the same region show, a significant difference between primary and secondary resistance can be expected with clarithromycin but not with the fluoroquinolones, tetracycline, and metronidazole 83 …”

Molecular characterization ofHelicobacter pyloriclinical isolates from Eastern Saudi Arabia

“…34 The overall resistance to CLR in Saudi Arabia was reported to range between 23-40%. 35,36 Several studies have linked the 23s rRNA gene mutations of H. pylori, including A2142G, A2143G, or T2182C, among others, to CLR resistance. 37 Nonetheless, multiple studies reported a discrepancy between the phenotypic resistance and mutation detection.…”

Review – Treatment of Helicobacter pylori infection 2020

“…An unprecedented number of studies last year reported on the important topic of antimicrobial resistance of H pylori strains 24‐60 . These are outlined in Table 1.…”