title: High prevalence of Helicobacter pylori infection with dual resistance to metronidazole and clarithromycin in Hong Kong.
abstract: BACKGROUND
  Metronidazole resistance is a common problem in most Asian countries, and clarithromycin has been widely used in Hong Kong.
  
  
  OBJECTIVE
  To determine the prevalence of Helicobacter pylori strains resistant to metronidazole and clarithromycin in Hong Kong and to assess the effect on eradication rates. Also to determine the genetic mutation in relation to phenotypic divergence in clarithromycin-resistant strains.
  
  
  METHODS
  H. pylori were cultured from gastric biopsies obtained from 87 patients during upper endoscopy. Minimal inhibitory concentrations of metronidazole and clarithromycin were determined by Etest and agar dilution methods. Mutations in clarithromycin-resistant strains were identified by polymerase chain reaction and restriction analysis. Random amplified polymorphic DNA fingerprinting was performed on clarithromycin-resistant and susceptible isolates.
  
  
  RESULTS
  The prevalences of H. pylori strains resistant to metronidazole and clarithromycin were 49.4% and 10.8%, respectively, in Hong Kong. Dual resistance to metronidazole and clarithromycin were found in 7. 2% of patients. The agreement between E-test and agar dilution methods was determined by error-rate bound analysis as 95.4% for metronidazole and 100% for clarithromycin. Dual resistant strains reduced the eradication rate to 66.7%. Among clarithromycin-resistant strains tested, all were due to A2144G point mutation in 23S rRNA gene. Random amplified polymorphic DNA fingerprinting suggested various phenotypically mixed populations.
  
  
  CONCLUSIONS
  The prevalence of metronidazole-resistant H. pylori strains remained static whilst the prevalence of clarithromycin-resistant strains was not rare in Hong Kong. An alarming 7.2% of patients were resistant to both the antimicrobials, which had a definite impact on treatment success. All cases of resistance to clarithromycin were due to A2144G mutation in 23S rRNA of H. pylori.
authors.affiliation: Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: W H
authors.initials: WH
authors.lastname: Wang
authors.forename: B C
authors.initials: BC
authors.lastname: Wong
authors.forename: A K
authors.initials: AK
authors.lastname: Mukhopadhyay
authors.forename: D E
authors.initials: DE
authors.lastname: Berg
authors.forename: C H
authors.initials: CH
authors.lastname: Cho
authors.forename: K C
authors.initials: KC
authors.lastname: Lai
authors.forename: W H
authors.initials: WH
authors.lastname: Hu
authors.forename: F M
authors.initials: FM
authors.lastname: Fung
authors.forename: W M
authors.initials: WM
authors.lastname: Hui
authors.forename: S K
authors.initials: SK
authors.lastname: Lam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017291:Clarithromycin / Q000494:pharmacology* / Q000627:therapeutic use; D004252:DNA Mutational Analysis; D018432:Drug Resistance, Multiple / Q000235:genetics*; D005260:Female; D005787:Gene Frequency; D016481:Helicobacter Infections / Q000188:drug therapy / Q000235:genetics / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000235:genetics; D006723:Hong Kong; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000494:pharmacology* / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017354:Point Mutation; D012338:RNA, Ribosomal, 23S / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D012338:RNA, Ribosomal, 23S; D008795:Metronidazole; D017291:Clarithromycin