title: Multi locus sequence typing (MLST) used as a tool to confirm the ability of susceptible Helicobacter pylori strains to gain resistance to clarithromycin during eradication therapy.
abstract: OBJECTIVE
  Primary resistance of H. pylori to clarithromycin is the most common reason for eradication failure, followed by mixed susceptible/ resistant H. pylori strain infection. To distinguish between mixed infections and H. pylori switch to resistance phenotype during eradication therapy, we proceeded with multi locus sequence typing (MLST) of H. pylori strains isolated from gastric biopsy samples of patients before and after eradication therapy.
  
  
  METHODS
  We collected H. pylori isolates from gastric biopsies from 133 patients who were never treated for H. pylori. Five patients had eradication failure with the first isolate susceptible and second isolate resistant to clarithromycin. To analyse genotypes of first and second H. pylori isolates, we compared H. pylori strain sequences of 7 housekeeping genes with MLST.
  
  
  RESULTS
  Five patients had clarithromycin-sensitive H. pylori before eradication therapy and gained H. pylori-resistant to clarithromycin after eradication therapy. The sensitive and resistant colonies of each of the H. pylori populations, taken from patients before/after antibiotic therapy, had identical sequence types (ST) obtained with MLST.
  
  
  CONCLUSIONS
  The factors favouring H. pylori survival and switch to antibiotic-resistance during eradication therapy probably enable milder environmental conditions for H. pylori persistence during therapy. One of such factor is the ineffective destruction of mucosa-adhered H. pylori by immune cells during therapy which may be due to locally induced immune deficit by H. pylori molecules like strain specific H. pylori lipopolysaccharides.
authors.forename: Miha
authors.initials: M
authors.lastname: Skvarc
authors.forename: Romina
authors.initials: R
authors.lastname: Kofol
authors.forename: Jeverica
authors.initials: J
authors.lastname: Samo
authors.forename: Andreja Natasa
authors.initials: AN
authors.lastname: Kopitar
authors.forename: Bojan
authors.initials: B
authors.lastname: Tepes
authors.forename: Alojz
authors.initials: A
authors.lastname: Ihan
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001706:Biopsy; D017291:Clarithromycin / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D005838:Genotype; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin