title: Functional and molecular surveillance of Helicobacter pylori antibiotic resistance in Kuala Lumpur.
abstract: BACKGROUND
  Helicobacter pylori is the etiological agent for diseases ranging from chronic gastritis and peptic ulcer disease to gastric adenocarcinoma and primary gastric B-cell lymphoma. Emergence of resistance to antibiotics possesses a challenge to the effort to eradicate H. pylori using conventional antibiotic-based therapies. The molecular mechanisms that contribute to the resistance of these strains have yet to be identified and are important for understanding the evolutional pattern and selective pressure imposed by the environment.
  
  
  RESULTS
  H. pylori was isolated from 102 patients diagnosed with gastrointestinal diseases, who underwent endoscopy at University Malaya Medical Centre (UMMC). The isolates were tested for their susceptibility on eleven antibiotics using Etest. Based on susceptibility test, 32.3% of the isolates were found to have primary metronidazole resistance; followed by clarithromycin (6.8%) and fluoroquinolones (6.8%). To further investigate the resistant strains, mutational patterns of gene rdxA, frxA, gyrA, gyrB, and 23S rRNA were studied. Consistent with the previous reports, metronidazole resistance was prevalent in the local population. However, clarithromycin, fluoroquinolone and multi-drug resistance were shown to be emerging. Molecular patterns correlated well with phenotypic data. Interestingly, multi-drug resistant (MDR) strains were found to be associated with higher minimum inhibitory concentration (MIC) than their single-drug resistant (SDR) counterparts. Most importantly, clarithromycin-resistant strains were suggested to have a higher incidence for developing multi-drug resistance.
  
  
  CONCLUSIONS
  Data from this study highlighted the urgency to monitor closely the prevalence of antibiotic resistance in the Malaysian population; especially that of clarithromycin and multi-drug resistance. Further study is needed to understand the molecular association between clarithromycin resistance and multi-drug resistance in H. pylori. The report serves a reminder that a strict antibiotic usage policy is needed in Malaysia and other developing countries (especially those where H. pylori prevalence remained high).
authors.affiliation: Department of Medical Microbiology, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia.
authors.forename: Xinsheng
authors.initials: X
authors.lastname: Teh
authors.affiliation: Department of Medical Microbiology, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia.
authors.forename: Yalda
authors.initials: Y
authors.lastname: Khosravi
authors.affiliation: Department of Medical Microbiology, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia.
authors.forename: Woon Ching
authors.initials: WC
authors.lastname: Lee
authors.affiliation: Department of Medicine, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia.
authors.forename: Alex Hwong Ruey
authors.initials: AH
authors.lastname: Leow
authors.affiliation: Department of Medical Microbiology, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia.
authors.forename: Mun Fai
authors.initials: MF
authors.lastname: Loke
authors.affiliation: Department of Medical Microbiology, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia.
authors.forename: Jamuna
authors.initials: J
authors.lastname: Vadivelu
authors.affiliation: Department of Medicine, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia.
authors.forename: Khean Lee
authors.initials: KL
authors.lastname: Goh
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D017291:Clarithromycin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D018432:Drug Resistance, Multiple; D024841:Fluoroquinolones / Q000494:pharmacology; D005798:Genes, Bacterial; D014644:Genetic Variation; D016481:Helicobacter Infections / Q000453:epidemiology* / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008795:Metronidazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D009154:Mutation; D015995:Prevalence; D012338:RNA, Ribosomal, 23S / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D012338:RNA, Ribosomal, 23S; D008795:Metronidazole; D017291:Clarithromycin