High primary resistance to metronidazole and levofloxacin, and a moderate resistance to clarithromycin in Helicobacter pylori isolated from Karnataka patients

Vignesh Shetty, Binit Lamichhane, Chin Yen Tay, Ganesh C. Pai, Ramachandra Lingadakai, Girisha Balaraju, Shiran Shetty, Mamatha Ballal, Eng Guan Chua

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Due to increased prevalence of H. pylori antimicrobial resistance worldwide and more importantly the resistance patterns vary between different geographical regions, it is important to survey local H. pylori antibiotic resistance profile to provide physicians with more informed drug choices to better treat H. pylori infection. To our knowledge, this is the first study to examine the prevalence of antimicrobial resistance of H. pylori in Karnataka state of South India. Results: A total of 113 H. pylori strains were isolated from gastric biopsies and tested: 81.4% were resistant to metronidazole, 54.9% were resistant to levofloxacin, 20.4% were resistant to clarithromycin, 5.3% were resistant to tetracycline and 7.1% were resistant to amoxicillin. Multidrug resistance was detected in 59.3% of total isolated strains, among which 86.6% were resistant to at least both metronidazole and levofloxacin. In this study, 38 out of 113 H. pylori strains had been whole-genome sequenced. Based on the draft genomes, RdxA and/or FrxA inactivation mutations were found to present in 75% of metronidazole-resistant strains. Clarithromycin-resistant strains had mainly A2143G and G2224A mutations in the 23 rRNA gene. While 87.1% levofloxacin-resistant strains had amino acid substitution mutations occurring predominantly at N87 and D91 in GyrA, novel mutations in the same protein including an insertion of five amino acid residues (QDNSV), immediately after the start codon, and a substitution mutation at R295 were identified. Conclusion: High primary resistance to metronidazole and levofloxacin, and a modest occurrence of clarithromycin resistance were revealed in H. pylori strains isolated from Karnataka patients. Therefore metronidazole-, levofloxacin- and clarithromycin-based triple therapies are not suitable as first-line treatment in Karnataka. Both amoxicillin and tetracycline can still be used to eradicate H. pylori infection in this region. We also revealed novel mutations in GyrA protein that possibly contribute to H. pylori resistance in levofloxacin, which merit further investigations.

Original languageEnglish
Article number21
JournalGut Pathogens
Volume11
Issue number1
DOIs
Publication statusPublished - 13-05-2019

Fingerprint

Levofloxacin
Clarithromycin
Metronidazole
Helicobacter pylori
Mutation
Amoxicillin
Helicobacter Infections
Tetracycline
Genome
DNA Gyrase
Initiator Codon
Multiple Drug Resistance
Amino Acid Substitution
Microbial Drug Resistance
rRNA Genes
India
Stomach
Physicians
Biopsy
Amino Acids

All Science Journal Classification (ASJC) codes

  • Parasitology
  • Microbiology
  • Gastroenterology
  • Virology
  • Infectious Diseases

Cite this

@article{425139206ad141cb92cd951b71d3476f,
title = "High primary resistance to metronidazole and levofloxacin, and a moderate resistance to clarithromycin in Helicobacter pylori isolated from Karnataka patients",
abstract = "Background: Due to increased prevalence of H. pylori antimicrobial resistance worldwide and more importantly the resistance patterns vary between different geographical regions, it is important to survey local H. pylori antibiotic resistance profile to provide physicians with more informed drug choices to better treat H. pylori infection. To our knowledge, this is the first study to examine the prevalence of antimicrobial resistance of H. pylori in Karnataka state of South India. Results: A total of 113 H. pylori strains were isolated from gastric biopsies and tested: 81.4{\%} were resistant to metronidazole, 54.9{\%} were resistant to levofloxacin, 20.4{\%} were resistant to clarithromycin, 5.3{\%} were resistant to tetracycline and 7.1{\%} were resistant to amoxicillin. Multidrug resistance was detected in 59.3{\%} of total isolated strains, among which 86.6{\%} were resistant to at least both metronidazole and levofloxacin. In this study, 38 out of 113 H. pylori strains had been whole-genome sequenced. Based on the draft genomes, RdxA and/or FrxA inactivation mutations were found to present in 75{\%} of metronidazole-resistant strains. Clarithromycin-resistant strains had mainly A2143G and G2224A mutations in the 23 rRNA gene. While 87.1{\%} levofloxacin-resistant strains had amino acid substitution mutations occurring predominantly at N87 and D91 in GyrA, novel mutations in the same protein including an insertion of five amino acid residues (QDNSV), immediately after the start codon, and a substitution mutation at R295 were identified. Conclusion: High primary resistance to metronidazole and levofloxacin, and a modest occurrence of clarithromycin resistance were revealed in H. pylori strains isolated from Karnataka patients. Therefore metronidazole-, levofloxacin- and clarithromycin-based triple therapies are not suitable as first-line treatment in Karnataka. Both amoxicillin and tetracycline can still be used to eradicate H. pylori infection in this region. We also revealed novel mutations in GyrA protein that possibly contribute to H. pylori resistance in levofloxacin, which merit further investigations.",
author = "Vignesh Shetty and Binit Lamichhane and Tay, {Chin Yen} and Pai, {Ganesh C.} and Ramachandra Lingadakai and Girisha Balaraju and Shiran Shetty and Mamatha Ballal and Chua, {Eng Guan}",
year = "2019",
month = "5",
day = "13",
doi = "10.1186/s13099-019-0305-x",
language = "English",
volume = "11",
journal = "Gut Pathogens",
issn = "1757-4749",
publisher = "BioMed Central",
number = "1",

}

High primary resistance to metronidazole and levofloxacin, and a moderate resistance to clarithromycin in Helicobacter pylori isolated from Karnataka patients. / Shetty, Vignesh; Lamichhane, Binit; Tay, Chin Yen; Pai, Ganesh C.; Lingadakai, Ramachandra; Balaraju, Girisha; Shetty, Shiran; Ballal, Mamatha; Chua, Eng Guan.

In: Gut Pathogens, Vol. 11, No. 1, 21, 13.05.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High primary resistance to metronidazole and levofloxacin, and a moderate resistance to clarithromycin in Helicobacter pylori isolated from Karnataka patients

AU - Shetty, Vignesh

AU - Lamichhane, Binit

AU - Tay, Chin Yen

AU - Pai, Ganesh C.

AU - Lingadakai, Ramachandra

AU - Balaraju, Girisha

AU - Shetty, Shiran

AU - Ballal, Mamatha

AU - Chua, Eng Guan

PY - 2019/5/13

Y1 - 2019/5/13

N2 - Background: Due to increased prevalence of H. pylori antimicrobial resistance worldwide and more importantly the resistance patterns vary between different geographical regions, it is important to survey local H. pylori antibiotic resistance profile to provide physicians with more informed drug choices to better treat H. pylori infection. To our knowledge, this is the first study to examine the prevalence of antimicrobial resistance of H. pylori in Karnataka state of South India. Results: A total of 113 H. pylori strains were isolated from gastric biopsies and tested: 81.4% were resistant to metronidazole, 54.9% were resistant to levofloxacin, 20.4% were resistant to clarithromycin, 5.3% were resistant to tetracycline and 7.1% were resistant to amoxicillin. Multidrug resistance was detected in 59.3% of total isolated strains, among which 86.6% were resistant to at least both metronidazole and levofloxacin. In this study, 38 out of 113 H. pylori strains had been whole-genome sequenced. Based on the draft genomes, RdxA and/or FrxA inactivation mutations were found to present in 75% of metronidazole-resistant strains. Clarithromycin-resistant strains had mainly A2143G and G2224A mutations in the 23 rRNA gene. While 87.1% levofloxacin-resistant strains had amino acid substitution mutations occurring predominantly at N87 and D91 in GyrA, novel mutations in the same protein including an insertion of five amino acid residues (QDNSV), immediately after the start codon, and a substitution mutation at R295 were identified. Conclusion: High primary resistance to metronidazole and levofloxacin, and a modest occurrence of clarithromycin resistance were revealed in H. pylori strains isolated from Karnataka patients. Therefore metronidazole-, levofloxacin- and clarithromycin-based triple therapies are not suitable as first-line treatment in Karnataka. Both amoxicillin and tetracycline can still be used to eradicate H. pylori infection in this region. We also revealed novel mutations in GyrA protein that possibly contribute to H. pylori resistance in levofloxacin, which merit further investigations.

AB - Background: Due to increased prevalence of H. pylori antimicrobial resistance worldwide and more importantly the resistance patterns vary between different geographical regions, it is important to survey local H. pylori antibiotic resistance profile to provide physicians with more informed drug choices to better treat H. pylori infection. To our knowledge, this is the first study to examine the prevalence of antimicrobial resistance of H. pylori in Karnataka state of South India. Results: A total of 113 H. pylori strains were isolated from gastric biopsies and tested: 81.4% were resistant to metronidazole, 54.9% were resistant to levofloxacin, 20.4% were resistant to clarithromycin, 5.3% were resistant to tetracycline and 7.1% were resistant to amoxicillin. Multidrug resistance was detected in 59.3% of total isolated strains, among which 86.6% were resistant to at least both metronidazole and levofloxacin. In this study, 38 out of 113 H. pylori strains had been whole-genome sequenced. Based on the draft genomes, RdxA and/or FrxA inactivation mutations were found to present in 75% of metronidazole-resistant strains. Clarithromycin-resistant strains had mainly A2143G and G2224A mutations in the 23 rRNA gene. While 87.1% levofloxacin-resistant strains had amino acid substitution mutations occurring predominantly at N87 and D91 in GyrA, novel mutations in the same protein including an insertion of five amino acid residues (QDNSV), immediately after the start codon, and a substitution mutation at R295 were identified. Conclusion: High primary resistance to metronidazole and levofloxacin, and a modest occurrence of clarithromycin resistance were revealed in H. pylori strains isolated from Karnataka patients. Therefore metronidazole-, levofloxacin- and clarithromycin-based triple therapies are not suitable as first-line treatment in Karnataka. Both amoxicillin and tetracycline can still be used to eradicate H. pylori infection in this region. We also revealed novel mutations in GyrA protein that possibly contribute to H. pylori resistance in levofloxacin, which merit further investigations.

UR - http://www.scopus.com/inward/record.url?scp=85065620994&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065620994&partnerID=8YFLogxK

U2 - 10.1186/s13099-019-0305-x

DO - 10.1186/s13099-019-0305-x

M3 - Article

AN - SCOPUS:85065620994

VL - 11

JO - Gut Pathogens

JF - Gut Pathogens

SN - 1757-4749

IS - 1

M1 - 21

ER -