1887

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Volume 72, Issue 11

High incidence of antibiotic resistance amongst isolates of collected in Nottingham, UK, between 2001 and 2018 Open Access

Abstract

is the leading cause of peptic ulcers and gastric cancer. The most common treatment regimens use combinations of two or three antibiotics and a proton pump inhibitor (PPI) to suppress stomach acid. The World Health Organization designated clarithromycin-resistant as a high priority pathogen for drug development, due to increasing antibiotic resistance globally.

There is no routine surveillance of primary antimicrobial sensitivities in the UK, and published data are lacking.

This study aimed to characterize antimicrobial sensitivities of isolates collected in Nottingham, UK, between 2001 and 2018.

Gastric biopsy samples were collected, with informed written consent and ethics approval, from 162 patients attending the Queen’s Medical Centre in Nottingham for an upper GI tract endoscopy. Antibiotic sensitivity was assessed using E-Tests and a more cost-effective disc diffusion test.

The clarithromycin, amoxicillin and levofloxacin disc diffusion tests provided identical results to E-Tests on a subset of 30 isolates. Disparities were observed in the metronidazole test results, however. In total, 241 isolates from 162 patients were tested using at least one method. Of all isolates, 28 % were resistant to clarithromycin, 62 % to metronidazole and 3 % to amoxicillin, which are used in first-line therapies. For those antibiotics used in second- and third-line therapies, 4 % were resistant to levofloxacin and none of the isolates were resistant to tetracycline. Resistance to more than one antibiotic was found in 27 % of isolates. The frequency of patients with a clarithromycin-resistant strain increased dramatically over time: from 16 % between 2001 and 2005 to 40 % between 2011 and 2018 (=0.011). For the same time periods, there was also an increase in those with a metronidazole-resistant strain (from 58 to 78 %; =0.05). The frequencies of clarithromycin and metronidazole resistance were higher in isolates from patients who had previously received eradication therapy, compared to those who had not (40 % versus 77 %, and 80 % versus 92 %, respectively). Of 79 pairs of isolates from the antrum and corpus regions of the same patient’s stomach, only six had differences in their antimicrobial susceptibility profiles.

Although there was high and increasing resistance to clarithromycin and metronidazole, there was no resistance to tetracycline and the frequencies of amoxicillin and levofloxacin resistance were very low.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): amoxicillin , antimicrobial resistance , clarithromycin , Helicobacter pylori , levofloxacin , metronidazole and susceptibility testing
Funding
This study was supported by the:
  • NIHR Nottingham Biomedical Research Centre (Award NIHR203310)
    • Principle Award Recipient: KarenRobinson
  • Medical Research Council (Award MR/R026343/1)
    • Principle Award Recipient: KarenRobinson
  • Wellcome Trust
    • Principle Award Recipient: ElizabethGarvey
© 2023 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
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2023-11-14
2024-04-30
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High incidence of antibiotic resistance amongst isolates of Helicobacter pylori collected in Nottingham, UK, between 2001 and 2018
J. Med. Microbiol. 72, 001776 (2023); https://doi.org/10.1099/jmm.0.001776
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