title: Different antibiotic susceptibility between antrum and corpus of the stomach, a possible reason for treatment failure of Helicobacter pylori infection.
abstract: OBJECTIVE
  To assess whether antibiotic resistance varies between the antrum and corpus of the stomach of patients that are either Helicobacter pylori (H. pylori) therapy-naive or pre-treated.
  
  
  METHODS
  H. pylori strains were isolated from antrum and corpus biopsies from 66 patients that received a diagnostic gastroduodenoscopy for variant clinical indications. Antimicrobial susceptibility to amoxicillin, clarithromycin, tetracycline, metronidazole, levofloxacin and rifabutin was tested with the E-test method on Iso-Sensitest agar with 10 vol% defibrinated horse blood. In patients with a different antibiotic susceptibility pattern between the isolates from the antrum and corpus, DNA fingerprinting via random amplified polymorphic DNA analysis was performed to detect differences among DNA patterns of H. pylori isolates.
  
  
  RESULTS
  Primary, secondary and tertiary resistance to clarithromycin was 6.9%, 53.8% and 83.3%, retrospectively. Metronidazole and levofloxacin resistance also increased according to the number of previous treatments (17.2%, 69.2%, 83.3%; 13.8%, 23.1%, 33.3%). Tertiary resistance to rifabutin was detected in 12.5% of patients. In none of the 66 patients a resistance against amoxicillin or tetracycline was detectable. Discordant antibiotic susceptibility between antrum and corpus isolates for different antibiotics was seen in 15.2% (10/66) of the patients. Two out of those ten patients were naive to any H. pylori antibiotic treatment. The remaining eight patients previously received at least one eradication therapy. DNA fingerprinting analysis revealed no substantial differences among DNA patterns between antrum and corpus isolates in the majority of patients suggesting an infection with a single H. pylori strain.
  
  
  CONCLUSIONS
  Different antibiotic susceptibility between antrum and corpus biopsies is a common phenomenon and a possible explanation for treatment failure. Resistant H. pylori strains may be missed if just one biopsy from one anatomic site of the stomach is taken for H. pylori susceptibility testing.
authors.affiliation: Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Selgrad
authors.affiliation: Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany.
authors.forename: Ina
authors.initials: I
authors.lastname: Tammer
authors.affiliation: Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany.
authors.forename: Cosima
authors.initials: C
authors.lastname: Langner
authors.affiliation: Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Bornschein
authors.affiliation: Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Meißle
authors.affiliation: Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Kandulski
authors.affiliation: Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany.
authors.forename: Mariya
authors.initials: M
authors.lastname: Varbanova
authors.affiliation: Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wex
authors.affiliation: Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Schlüter
authors.affiliation: Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004269:DNA, Bacterial / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D004384:Duodenoscopy; D005260:Female; D005773:Gastroscopy; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011237:Predictive Value of Tests; D011706:Pyloric Antrum / Q000187:drug effects* / Q000382:microbiology; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial
keywords: Antibiotic susceptibility; Helicobacter pylori treatment; Heteroresistance