Premium
Mixed‐Infection of Antibiotic Susceptible and Resistant Helicobacter pylori Isolates in a Single Patient and Underestimation of Antimicrobial Susceptibility Testing
Author(s) -
Kim Jae J.,
Kim Jong G.,
Kwon Dong H.
Publication year - 2003
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1046/j.1523-5378.2003.00145.x
Subject(s) - helicobacter pylori , antibiotics , clarithromycin , genotype , tetracycline , amoxicillin , microbiology and biotechnology , antibiotic resistance , metronidazole , biology , nitrofurantoin , genetics , gene
Antibiotic resistance among Helicobacter pylori has been increasing worldwide and has begun to affect the overall efficacy of current antibiotic regimens adversely. We examined 220 pairs of H. pylori isolates obtained from both the antrum and corpus of separate patients; 109 (50%) harbored antibiotic‐resistant H. pylori : amoxicillin (0.5%), clarithromycin (5.9%), furazolidone (1.4%), metronidazole (45.5%), nitrofurantoin (1.4%), and tetracycline (6.8%). Heteroresistance among the two biopsy sites from each patient was present in 41 of the 109 patients (38%) with antibiotic resistant H. pylori (e.g. 34% with resistant strains would be misclassified as susceptible if a biopsy of the antrum alone used for antimicrobial susceptibility testing). DNA fingerprinting genotype analysis was carried out on the 41 pairs of isolates with heteroresistance. While different patients had different fingerprinting patterns, each pair of isolates showed identical or similar fingerprinting patterns. These results suggest that antibiotic‐resistant H. pylori typically develop from pre‐existing susceptible strain rather than coinfection with a different strain. The minor differences in genotype (degeneration of genotype) seen reflect one of the processes for development of genetic diversity in H. pylori . No biopsy single site can be considered representative for antimicrobial susceptibility testing.