title: Detection of primary clarithromycin resistance of Helicobacter pylori and association between cagA               (+) status and clinical outcome.
abstract: Helicobacter pylori was examined in 110 patients (82 (74.5) with gastritis, 18 (16.4) with duodenitis, six (5.5) with duodenal ulcer and gastroesophageal reflux, and four (3.6 %) with normal) with gastrointestinal problems living in rural area, no history of macrolide use, and detected by culture (71.8) or direct detection from gastric biopsies by PCR (82.7 %). Also, cagA gene was identified using PCR and was found positive in 68/91 (74.7 %) strains. The prevalence of clarithromycin-resistant H. pylori was investigated by two methods including PCR-RFLP (7.7 (A2142G 1.1 and A2143G 6.6 %)) and twofold agar dilution (8.9 %) to detect phenotypic and genotypic status simultaneously. Among all the H. pylori positive patients, eight (8.8 %) isolates were found to be resistant to clarithromycin by at least one of the AD and/or PCR-RFLP methods. H. pylori positive rates were significantly correlated with patients' sex, age, and endoscopic findings (p = 0.040, <0.001 and <0.001, respectively). There were no differences in gender or endoscopic findings related to cagA                 (+) and cagA                 (-) patients. The gene of cagA was not significantly helpful in predicting the clinical outcome of H. pylori infection alone. In conclusion, we revealed that there was a low prevalence of primer clarithromycin resistance in patients living in rural area with no history of macrolide use. The prevalence of mutant strains among the macrolide-resistant H. pylori varies even geographically between close provinces.
authors.affiliation: Department of Medical Microbiology, University of Mustafa Kemal, Antakya, Hatay, Turkey. erkanyula@gmail.com
authors.forename: Erkan
authors.initials: E
authors.lastname: Yula
authors.forename: Toğrul
authors.initials: T
authors.lastname: Nagiyev
authors.forename: Ozlem Aycan
authors.initials: OA
authors.lastname: Kaya
authors.forename: Melek
authors.initials: M
authors.lastname: Inci
authors.forename: M Murat
authors.initials: MM
authors.lastname: Celik
authors.forename: Fatih
authors.initials: F
authors.lastname: Köksal
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000235:genetics*; D001426:Bacterial Proteins / Q000235:genetics*; D001706:Biopsy; D017291:Clarithromycin / Q000494:pharmacology* / Q000627:therapeutic use; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000473:pathology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D012424:Rural Population; D016896:Treatment Outcome; D014421:Turkey; D037521:Virulence Factors / Q000235:genetics; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D037521:Virulence Factors; C080866:cagA protein, Helicobacter pylori; D017291:Clarithromycin