1887

Journal of Medical Microbiology logo

Volume 58, Issue 7

Prevalence of multidrug-resistant in Bulgaria Free

Abstract

The aim of this study was to evaluate the presence and prevalence of multidrug antibacterial resistance in in Bulgaria from 2005 to 2008. The resistance in 828 untreated adults, 124 treated adults and 105 untreated children was, respectively, 26.5, 50.8 and 16.2 % for metronidazole; 18.4, 45.2 and 19 % for clarithromycin; 1, 2.4 and 0 % for amoxicillin; 4.4, 10.6 and 1.9 % for tetracycline; and 9, 14.5 and 5.8 % for ciprofloxacin. Triple resistance to the evaluated agents was uncommon and was detected in 1 % of the untreated children, 3.5 % of the untreated adults and 13.6 % of the treated adults. Five strains were resistant to amoxicillin, metronidazole and clarithromycin, two of them exhibiting quadruple resistance. Resistance to four of the five antibacterials tested was found in 0.7 % of the untreated and 1.8 % of the treated adults. The overall level of multidrug resistance in the treated adults (15.4 %) was higher than that in the untreated adults (4.2 %, =0.0001) and the untreated children (1 %, =0.0001). The presence of multidrug resistance in Bulgaria could be associated with many factors, among them the slightly increasing national use of macrolides, lincosamides and streptogramins and of quinolones since 2000, the significant increase in primary clarithromycin resistance, the high tetracycline use between 1994 and 1999, and, in individual cases, the use of azithromycin-based regimens or reuse of nitroimidazoles. In conclusion, for the first time in a European country during the last 5 years, strains harbouring a worrying quadruple antibacterial resistance were found in treated as well as in untreated patients. susceptibility patterns have a tendency to become unpredictable and should be monitored constantly at both national and global levels.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): BST, breakpoint susceptibility testing , DID, defined daily doses per 1000 inhabitants per day , GORD, gastro-oesophageal reflux disease and PPI, proton pump inhibitor
SGM
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.009993-0
2009-07-01
2024-04-23
Loading full text...

Full text loading...

/deliver/fulltext/jmm/58/7/930.html?itemId=/content/journal/jmm/10.1099/jmm.0.009993-0&mimeType=html&fmt=ahah

References

  1. Anagnostopoulos G. K., Kostopoulos P., Margantinis G., Tsiakos S., Arvanitidis D. 2003; Omeprazole plus azithromycin and either amoxicillin or tinidazole for eradication of Helicobacter pylori infection. J Clin Gastroenterol 36:325–328 [CrossRef]
     [Google Scholar]
  2. Bazzoli F., Berretti D., De Luca L., Nicolini G., Pozzato P., Fossi S., Zagari M. 1999; What can be learnt from the new data about antibiotic resistance? Are there any practical clinical consequences of Helicobacter pylori antibiotic resistance?. Eur J Gastroenterol Hepatol 11 (Suppl. 2):S39–S42 [CrossRef]
     [Google Scholar]
  3. Boyanova L., Gergova G., Nikolov R., Davidkov L., Kamburov V., Jelev C., Mitov I. 2008; Prevalence and evolution of Helicobacter pylori resistance to 6 antibacterial agents over 12 years and correlation between susceptibility testing methods. Diagn Microbiol Infect Dis 60:409–415 [CrossRef]
     [Google Scholar]
  4. Chen J., Chen F. B., Yu J. D., Chen X. J., Li Z. Y., Zhang X. P. 2004; Prevalence of Helicobacter pylori resistant to clarithromycin, amoxicillin and metronidazole in children. Zhonghua Er Ke Za Zhi 42:769–771
     [Google Scholar]
  5. Chisholm S. A., Teare E. L., Davies K., Owen R. J. 2007; Surveillance of primary antibiotic resistance of Helicobacter pylori at centres in England and Wales over a six-year period (2000–2005). Euro Surveill 12:E3–E4
     [Google Scholar]
  6. Di Mario F., Cavallaro L. G., Scarpignato C. 2006; ‘Rescue’ therapies for the management of Helicobacter pylori infection. Dig Dis 24:113–130 [CrossRef]
     [Google Scholar]
  7. Domingo D., Alarcón T., Vega A. E., García J. A., Martínez M. J., López-Brea M. 2002; Microbiological factors that influence the eradication of Helicobacter pylori in adults and children. Enferm Infecc Microbiol Clin 20:431–434 [CrossRef]
     [Google Scholar]
  8. Gisbert J. P., Pajares J. M. 2005; Helicobacter pylori “rescue” therapy after failure of two eradication treatments. Helicobacter 10:363–372 [CrossRef]
     [Google Scholar]
  9. Glocker E., Stueger H. P., Kist M. 2007; Quinolone resistance in Helicobacter pylori isolates in Germany. Antimicrob Agents Chemother 51:346–349 [CrossRef]
     [Google Scholar]
  10. Gosciniak G., Iwanczak B., Przondo-Mordarska A., Grabinska J., Iwanczak F. 2004; High level of resistance to metronidazole and clarithromycin in Helicobacter pylori isolated from pediatric patients in Poland (1997–2001). Folia Microbiol (Praha) 49:133–136 [CrossRef]
     [Google Scholar]
  11. Han S. R., Bhakdi S., Maeurer M. J., Schneider T., Gehring S. 1999; Stable and unstable amoxicillin resistance in Helicobacter pylori : should antibiotic resistance testing be performed prior to eradication therapy?. J Clin Microbiol 37:2740–2741
     [Google Scholar]
  12. Hsu P. I., Wu D. C., Chen A., Peng N. J., Tseng H. H., Tsay F. W., Lo G. H., Lu C. Y., Yu F. J., Lai K. H. 2008; Quadruple rescue therapy for Helicobacter pylori infection after two treatment failures. Eur J Clin Invest 38:404–409 [CrossRef]
     [Google Scholar]
  13. Hu C. T., Wu C. C., Lin C. Y., Cheng C. C., Su S. C., Tseng Y. H., Lin N. T. 2007; Resistance rate to antibiotics of Helicobacter pylori isolates in eastern Taiwan. J Gastroenterol Hepatol 22:720–723
     [Google Scholar]
  14. Kalach N., Serhal L., Asmar E., Campeotto F., Bergeret M., Dehecq E., Spyckerelle C., Charkaluk M. L., Decoster A. other authors 2007; Helicobacter pylori primary resistant strains over 11 years in French children. Diagn Microbiol Infect Dis 59:217–222 [CrossRef]
     [Google Scholar]
  15. Kim J. M. 2006; Antibiotic resistance of Helicobacter pylori isolated from Korean patients. Korean J Gastroenterol 47:337–349
     [Google Scholar]
  16. Kim N., Kim J. M., Kim C. H., Park Y. S., Lee D. H., Kim J. S., Jung H. C., Song I. S. 2006; Institutional difference of antibiotic resistance of Helicobacter pylori strains in Korea. J Clin Gastroenterol 40:683–687 [CrossRef]
     [Google Scholar]
  17. Kobayashi I., Murakami K., Kato M., Kato S., Azuma T., Takahashi S., Uemura N., Katsuyama T., Fukuda Y. other authors 2007; Changing antimicrobial susceptibility epidemiology of Helicobacter pylori strains in Japan between 2002 and 2005. J Clin Microbiol 45:4006–4010 [CrossRef]
     [Google Scholar]
  18. Koletzko S., Richy F., Bontems P., Crone J., Kalach N., Monteiro M. L., Gottrand F., Celinska-Cedro D., Roma-Giannikou E. other authors 2006; Prospective multicentre study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe. Gut 55:1711–1716 [CrossRef]
     [Google Scholar]
  19. Kutschke A., de Jonge B. L. 2005; Compound efflux in Helicobacter pylori . Antimicrob Agents Chemother 49:3009–3010 [CrossRef]
     [Google Scholar]
  20. Kwon D. H., Dore M. P., Kim J. J., Kato M., Lee M., Wu J. Y., Graham D. Y. 2003; High-level β -lactam resistance associated with acquired multidrug resistance in Helicobacter pylori . Antimicrob Agents Chemother 47:2169–2178 [CrossRef]
     [Google Scholar]
  21. Lesbros-Pantoflickova D., Corthésy-Theulaz I., Blum A. L. 2007; Helicobacter pylori and probiotics. J Nutr 137 (Suppl. 2):812S–818S
     [Google Scholar]
  22. Magaret N., Burm M., Faigel D., Kelly C., Peterson W., Fennerty M. B. 2001; A randomized trial of lansoprazole, amoxycillin, and clarithromycin versus lansoprazole, bismuth, metronidazole and tetracycline in the retreatment of patients failing initial Helicobacter pylori therapy. Dig Dis 19:174–178 [CrossRef]
     [Google Scholar]
  23. Malfertheiner P., Megraud F., O'Morain C., Bazzoli F., El-Omar E., Graham D., Hunt R., Rokkas T., Vakil N., Kuipers E. J. 2007; Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 56:772–781 [CrossRef]
     [Google Scholar]
  24. Markova B., Proevcska J., Benisheva T., Valcheva J., Popova M. 2005; Antibiotic use and microbial resistance: data from the ESCMID projects EARSS and ESAC for Bulgaria. In Proceedings of the 1st Conference of the Bulgarian Association of Medical Microbiology: Rational Antibiotic Policy Sofia, Bulgaria:
     [Google Scholar]
  25. Megraud F. 2004; H. pylori antibiotic resistance: prevalence, importance, and advances in testing. Gut 53:1374–1384 [CrossRef]
     [Google Scholar]
  26. Megraud F., Lehours P. 2007; Helicobacter pylori detection and antimicrobial susceptibility testing. Clin Microbiol Rev 20:280–322 [CrossRef]
     [Google Scholar]
  27. Mégraud F., Lehn N., Lind T., Bayerdörffer E., O'Morain C., Spiller R., Unge P., van Zanten S. V., Wrangstadh M., Burman C. F. 1999; Antimicrobial susceptibility testing of Helicobacter pylori in a large multicenter trial: the MACH 2 study. Antimicrob Agents Chemother 43:2747–2752
     [Google Scholar]
  28. Miyachi H., Miki I., Aoyama N., Shirasaka D., Matsumoto Y., Toyoda M., Mitani T., Morita Y., Tamura T. other authors 2006; Primary levofloxacin resistance and gyrA / B mutations among Helicobacter pylori in Japan. Helicobacter 11:243–249 [CrossRef]
     [Google Scholar]
  29. Morgner A., Labenz J., Miehlke S. 2006; Effective regimens for the treatment of Helicobacter pylori infection. Expert Opin Investig Drugs 15:995–1016 [CrossRef]
     [Google Scholar]
  30. Muller A., Coenen S., Monnet D. L., Goossens H. 2007; European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe, 1998–2005. Euro Surveill 12:E071011–1
     [Google Scholar]
  31. NCCLS 2000 Performance Standards for Antimicrobial Susceptibility Testing . Tenth Informational Supplement. Approved standard M100-S10 (M7 Wayne, PA: National Committee for Clinical Laboratory Standards;
     [Google Scholar]
  32. Nishizawa T., Suzuki H., Kurabayashi K., Masaoka T., Muraoka H., Mori M., Iwasaki E., Kobayashi I., Hibi T. 2006; Gatifloxacin resistance and mutations in gyrA after unsuccessful Helicobacter pylori eradication in Japan. Antimicrob Agents Chemother 50:1538–1540 [CrossRef]
     [Google Scholar]
  33. Peitz U., Sulliga M., Wolle K., Leodolter A., Von Arnim U., Kahl S., Stolte M., Borsch G., Labenz J., Malfertheiner P. 2002; High rate of post-therapeutic resistance after failure of macrolide-nitroimidazole triple therapy to cure Helicobacter pylori infection: impact of two second-line therapies in a randomized study. Aliment Pharmacol Ther 16:315–324 [CrossRef]
     [Google Scholar]
  34. Saidijam M., Benedetti G., Ren Q., Xu Z., Hoyle C. J., Palmer S. L., Ward A., Bettaney K. E., Szakonyi G. other authors 2006; Microbial drug efflux proteins of the major facilitator superfamily. Curr Drug Targets 7:793–811 [CrossRef]
     [Google Scholar]
  35. Thyagarajan S. P., Ray P., Das B. K., Ayyagari A., Khan A. A., Dharmalingam S., Rao U. A., Rajasambandam P., Ramathilagam B. other authors 2003; Geographical difference in antimicrobial resistance pattern of Helicobacter pylori clinical isolates from Indian patients: multicentric study. J Gastroenterol Hepatol 18:1373–1378 [CrossRef]
     [Google Scholar]
  36. Toracchio S., Marzio L. 2003; Primary and secondary antibiotic resistance of Helicobacter pylori strains isolated in central Italy during the years 1998–2002. Dig Liver Dis 35:541–545 [CrossRef]
     [Google Scholar]
  37. Torres J., Camorlinga-Ponce M., Pérez-Pérez G., Madrazo-De la Garza A., Dehesa M., González-Valencia G., Muñoz O. 2001; Increasing multidrug resistance in Helicobacter pylori strains isolated from children and adults in Mexico. J Clin Microbiol 39:2677–2680 [CrossRef]
     [Google Scholar]
  38. Tüzün Y., Bayan K., Yilmaz S., Dursun M., Ozekinci T. 2008; The prevalence of primary and secondary Helicobacter pylori resistance to clarithromycin and probable contributing cofactors: data from southeastern Anatolia. Hepatogastroenterology 55:289–293
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.009993-0
Loading
Prevalence of multidrug-resistant Helicobacter pylori in Bulgaria
J. Med. Microbiol. 58, 930 (2009); https://doi.org/10.1099/jmm.0.009993-0
/content/journal/jmm/10.1099/jmm.0.009993-0
/content/journal/jmm/10.1099/jmm.0.009993-0
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error