title: Alaska sentinel surveillance for antimicrobial resistance in Helicobacter pylori isolates from Alaska native persons, 1999-2003.
abstract: BACKGROUND
  Previous studies in Alaska have demonstrated elevated proportions of antimicrobial resistance among Helicobacter pylori isolates.
  
  
  METHODS
  We analyzed H. pylori data from the Centers for Disease Control and Prevention (CDC)'s sentinel surveillance in Alaska from July 1999 to June 2003 to determine the proportion of culture-positive biopsies from Alaska Native persons undergoing routine upper-endoscopy, and the susceptibility of H. pylori isolates to metronidazole [minimum inhibitory concentration (MIC) of > 8 g metronidazole/mL), clarithromycin (MIC > or = 1), tetracycline (MIC > or = 2) and amoxicillin (MIC > or = 1)] using agar dilution.
  
  
  RESULTS
  Nine-hundred sixty-four biopsy specimens were obtained from 687 participants; 352 (51%) patients tested culture positive. Mean age of both culture-positive and culture-negative patients was 51 years. Metronidazole resistance was demonstrated in isolates from 155 (44%) persons, clarithromycin resistance from 108 (31%) persons, amoxicillin resistance from 8 (2%) persons, and 0 for tetracycline resistance. Metronidazole and clarithromycin resistance varied by geographic region. Female patients were more likely than male subjects to show metronidazole resistance (p < .01) and clarithromycin resistance (p = .05).
  
  
  CONCLUSIONS
  Resistance to metronidazole and clarithromycin is more common among H. pylori isolates from Alaska Native persons when compared with those from elsewhere in the USA.
authors.affiliation: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK 99508, USA. zwa8@cdc.gov
authors.forename: Michael G
authors.initials: MG
authors.lastname: Bruce
authors.forename: Dana L
authors.initials: DL
authors.lastname: Bruden
authors.forename: Brian J
authors.initials: BJ
authors.lastname: McMahon
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
authors.forename: Alisa
authors.initials: A
authors.lastname: Reasonover
authors.forename: Julie
authors.initials: J
authors.lastname: Morris
authors.forename: Debby A
authors.initials: DA
authors.lastname: Hurlburt
authors.forename: Helen
authors.initials: H
authors.lastname: Peters
authors.forename: Frank
authors.initials: F
authors.lastname: Sacco
authors.forename: Patrick
authors.initials: P
authors.lastname: Martinez
authors.forename: Michael
authors.initials: M
authors.lastname: Swenson
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Berg
authors.forename: Debra
authors.initials: D
authors.lastname: Parks
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Parkinson
mesh_terms: D000328:Adult; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D000658:Amoxicillin / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000890:Anti-Infective Agents / Q000494:pharmacology*; D001706:Biopsy; D017291:Clarithromycin / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000494:pharmacology*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D044382:Population Groups; D018571:Sentinel Surveillance; D013270:Stomach / Q000382:microbiology / Q000473:pathology; D013752:Tetracycline / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole; D000658:Amoxicillin; D013752:Tetracycline; D017291:Clarithromycin