Genetic antibiotic resistance of helicobacter pylori in South-Eastern Romania

Abstract

Background & Aims: Helicobacter pylori (H. pylori) infection is widespread, affecting about half of the world‘s population. The increasing prevalence of strains resistant to antimicrobial agents is a critical issue for the eradication rate of H. pylori. With the rapid development of molecular pathology, some molecular markers have been confirmed to be associated with antibiotic resistance. This study investigated the genetic antibiotic resistance of H. pylori in the south-eastern region of Romania. Methods: The study was addressed to an adult population of patients from Constanța County, Romania with uninvestigated dyspepsia who had not previously received H. pylori eradication therapy. Out of 321 tested patients who met the inclusion and exclusion criteria, 90 (38.9%) had positive rapid urease test from gastric biopsy samples. Primary genetic resistance to antibiotics (fluoroquinolone and clarithromycin) was tested by the GenoType HelicoDR kit (Hain Lifescience GmbH, Germany). Results: Out of 90 patients whose samples were tested, the majority were female, 59/90 (65.5%) and the mean age was 46.6 ± 14.7 years. Primary clarithromycin resistance mutations were detected in 18/90 (20%) of patients, the most common mutation in our study being A2147G (associated with a high level of clarithromycin resistance and lower cure rates); other mutations were A2147G, A2146G and A2146C. Primary fluoroquinolones resistance mutations were detected in 27/90 (30%) of patients, and the most common mutations were D91N, D91G, and N87K. There was no correlation with patients‘ gender or age. Conclusions: Clarithromycin and fluoroquinolone resistance of H. pylori was moderately high in our study. The type of mutation responsible for clarithromycin resistance is the one with more chances of eradication failure (A2147G). There is a need for monitoring H. pylori resistance patterns in Romania to provide data that can guide empirical treatment. This is the first published study on the genetic resistance of H. pylori in Romania.