Patricio González-Hormazábal1, Alex Arenas2, Carolina Serrano3, Margarita Pizarro4, Eduardo Fuentes-López5, Jorge Arnold4, Zoltan Berger6, Maher Musleh7, Héctor Valladares7, Enrique Lanzarini7, Lilian Jara8, V Gonzalo Castro8, M Constanza Camargo9, Arnoldo Riquelme10. 1. Program de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile. Electronic address: patriciogonzalez@uchile.cl. 2. Hospital Dr. Sótero del Río, Santiago, Chile; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile. 3. Departamento de Gastroenterología y Nutrición Pediátrica. Escuela de Medicina, Pontificia Universidad Católica de Chile. 4. Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile. 5. Departamento de Ciencias de la Salud, Facultad de Medicina. Pontificia Universidad Católica de Chile. 6. Sección de Gastroenterología, Hospital Clínico de la Universidad de Chile, Santiago, Chile. 7. Departamento de Cirugía, Hospital Clínico de la Universidad de Chile, Santiago, Chile. 8. Program de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile. 9. Division of Cancer Epidemiology and Genetics, National Cancer Institute, USA. 10. Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile; Departamento de Ciencias de la Salud, Facultad de Medicina. Pontificia Universidad Católica de Chile.
Abstract
BACKGROUND: Treatments for Helicobacter pylori (H. pylori) eradication include the use of antibiotics and a proton-pump inhibitor. Antibiotic resistance is a major concern for two drugs: levofloxacin and clarithromycin. The aim was to determine the prevalence of levofloxacin resistance (LevoR) and clarithromycin resistance (ClaR) in an urban population in Santiago, Chile. METHODS: Gastric mucosa biopsies were obtained for DNA isolation from 143 H. pylori-positive individuals aged 18-80 years. Direct sequencing of the quinolone-resistance determining region (QRDR) of the gyrA gene was used to determine LevoR. ClaR was determined using restriction-fragment length polymorphism or 5'exonuclease assay. RESULTS: The prevalences of LevoR and ClaR were 29 and 27%, respectively. LevoR was higher in women than in men (39 vs. 13%, p <0.001), while no sex difference was observed for ClaR (p = 0.123). The prevalence of LevoR increased with age (p-trend = 0.004) but not for ClaR (p-trend = 0.054). In sex-stratified analyses, both LevoR and ClaR increased with age only among women. Older women (>50 years) had a higher probability to carry LevoR strains as compared to men. The prevalence of dual LevoR and ClaR was 12.6%. CONCLUSIONS: The prevalence of ClaR and LevoR is high in Santiago, according to International guidelines that recommend avoiding schemes with antibiotic resistance >15%. Our findings provide evidence to re-evaluate current therapies and guide empirical first- and second-line eradication treatments in Chile.
BACKGROUND: Treatments for Helicobacter pylori (H. pylori) eradication include the use of antibiotics and a proton-pump inhibitor. Antibiotic resistance is a major concern for two drugs: levofloxacin and clarithromycin. The aim was to determine the prevalence of levofloxacin resistance (LevoR) and clarithromycin resistance (ClaR) in an urban population in Santiago, Chile. METHODS: Gastric mucosa biopsies were obtained for DNA isolation from 143 H. pylori-positive individuals aged 18-80 years. Direct sequencing of the quinolone-resistance determining region (QRDR) of the gyrA gene was used to determine LevoR. ClaR was determined using restriction-fragment length polymorphism or 5'exonuclease assay. RESULTS: The prevalences of LevoR and ClaR were 29 and 27%, respectively. LevoR was higher in women than in men (39 vs. 13%, p <0.001), while no sex difference was observed for ClaR (p = 0.123). The prevalence of LevoR increased with age (p-trend = 0.004) but not for ClaR (p-trend = 0.054). In sex-stratified analyses, both LevoR and ClaR increased with age only among women. Older women (>50 years) had a higher probability to carry LevoR strains as compared to men. The prevalence of dual LevoR and ClaR was 12.6%. CONCLUSIONS: The prevalence of ClaR and LevoR is high in Santiago, according to International guidelines that recommend avoiding schemes with antibiotic resistance >15%. Our findings provide evidence to re-evaluate current therapies and guide empirical first- and second-line eradication treatments in Chile.
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