Prevalence and Antibiotic Resistance Patterns of Helicobacter pylori Infection in Koh Kong, Cambodia

Abstract

Background: Gastric cancer, which is the leading cause of cancer mortality in Cambodia, can be prevented by Helicobacter pylori (H. pylori) eradication. There is limited data about H. pylori strains in Cambodia. This study aimed to evaluate H. pylori prevalence and antibiotic resistance in Koh Kong, Cambodia. Methods: 118 Cambodian dyspeptic patients were scheduled to enter this study and 58 were enrolled between July and September 2019. All patients underwent upper GI endoscopy. 3 gastric biopsies were obtained for rapid urease test, H. pylori culture with E-test and GenoType® HelicoDr (Hain Lifescience factory, Germany). 3-mL blood sample was collected for CYP2C19 genotyping. Results: 58 subjects were enrolled (40 females, 18 males, mean age 43.8 years). Overall H. pylori prevalence was 31.0%. Antibiotic resistance rates were 78.6% for metronidazole, 50.0% for fluoroquinolones, and 27.8% for clarithromycin. There was no amoxicillin and tetracycline resistance. More than half of H. pylori strains (57.1%) were multidrug-resistant. Most (35.7%) were resistant to metronidazole and quinolone. Poor, intermediate and rapid metabolizers were 5.5%, 38.9% and 55.6%, respectively. Conclusions: H. pylori infection remains common infection in Cambodia. High prevalence of clarithromycin, metronidazole, levofloxacin and multidrug-resistant H. pylori is still major problems in Cambodia. Treatment regimens without clarithromycin and quinolone such as 14-day bismuth-based quadruple therapy might be an appropriate choice for H. pylori eradication in this particular area.

Emergence of amoxicillin resistance and identification of novel mutations of the pbp1A gene in Helicobacter pylori in Vietnam

“…The amoxicillin-resistant H. pylori proportion discovered in this study (25.7%) was similar to the finding by Saniee et al in Iran (27.1%; p = 0.423) in 2018 [ 23 ] but significantly higher than that in other studies, such as Zerbetto et al in Argentina (7.6%, p < 0.001) in 2017 [ 15 ], Manal et al in Egypt (18.3%; p = 0.035) in 2018 [ 24 ], Ortis et al in Central America (10%; p < 0.001) in 2019 [ 25 ], Azzaya et al in Mongolia (11.9%; p < 0.001), Aumpan et al in Cambodia (0%; p < 0.001) in 2020 [ 26 , 27 ], Calinga-Ponce et al in Mexico (1.8%; p < 0.001) and Li et al in China (0%; p < 0.001) in 2021 [ 28 , 29 ]. Compared to previous studies in Vietnam, the amoxicillin resistance proportion has been trending up significantly, for instance, from 0% ( p < 0.001) in 2013 [ 30 ], 1.1% ( p < 0.001) in 2015 [ 8 ], 10.4% ( p < 0.001) in 2016 [ 9 ], 15% ( p = 0.002) in 2019 [ 3 ] and to 25.7% in 2020 for this study.…”

Prognostic factors for survival in patients with gastric adenocarcinoma

“…Helicobacter pylori , a gram‐negative rod‐shaped bacterium, has been recognized as the most important factor associated with gastric cancer 5‐7 . H. pylori infection causes persistent gastric mucosal inflammation producing oxidative stress and DNA damage.…”

“…4 Helicobacter pylori, a gram-negative rod-shaped bacterium, has been recognized as the most important factor associated with gastric cancer. [5][6][7] H. pylori infection causes persistent gastric mucosal inflammation producing oxidative stress and DNA damage. Gastric glands subsequently undergo precancerous differentiation and eventually become malignant cells.…”

Antibiotic resistance in Helicobacter pylori: From potential biomolecular mechanisms to clinical practice

“…This problem was equally serious in Chongqing, Ningbo, and Shanghai, with MDR rates of 48.2%, 116 32.06%, 111 and 33.9%, 117 respectively. Other regions in Asia, such as Cambodia and Korea, have found that 57.1% 118 and 42.9% 79 of strains were resistant to more than one antibiotic. Similarly, primary MDR rates ranged from <10% in most European countries to >40% in Peru 119 .…”