Abstract
We evaluated biofilm formation of clinical Helicobacter pylori isolates from Indonesia and its relation to antibiotic resistance. We determined the minimum inhibition concentration (MIC) of amoxicillin, clarithromycin, levofloxacin, metronidazole and tetracycline by the Etest to measure the planktonic susceptibility of 101 H. pylori strains. Biofilms were quantified by the crystal violet method. The minimum biofilm eradication concentration (MBEC) was obtained by measuring the survival of bacteria in a biofilm after exposure to antibiotics. The majority of the strains formed a biofilm (93.1% (94/101)), including weak (75.5%) and strong (24.5%) biofilm-formers. Planktonic resistant and sensitive strains produced relatively equal amounts of biofilms. The resistance proportion, shown by the MBEC measurement, was higher in the strong biofilm group for all antibiotics compared to the weak biofilm group, especially for clarithromycin (p = 0.002). Several cases showed sensitivity by the MIC measurement, but resistance according to the MBEC measurements (amoxicillin, 47.6%; tetracycline, 57.1%; clarithromycin, 19.0%; levofloxacin, 38.1%; and metronidazole 38.1%). Thus, biofilm formation may increase the survival of H. pylori and its resistance to antibiotics. Biofilm-related antibiotic resistance should be evaluated with antibiotic susceptibility.
Highlights
A decrease in the cure rate of Helicobacter pylori infection after treatment with the first-line regimen has been reported in various areas of the world as a result of high antibiotic resistance [1].Persistent infection with H. pylori can induce the development of gastroduodenal diseases such as peptic ulcer disease and gastric cancer
We aimed to evaluate biofilm formation of clinical isolates obtained from an Indonesian nationwide survey
We investigated the correlation between planktonic resistance, biofilm formation and biofilm resistance to five commonly used antibiotics: amoxicillin, clarithromycin, metronidazole, levofloxacin and tetracycline
Summary
A decrease in the cure rate of Helicobacter pylori infection after treatment with the first-line regimen has been reported in various areas of the world as a result of high antibiotic resistance [1].Persistent infection with H. pylori can induce the development of gastroduodenal diseases such as peptic ulcer disease and gastric cancer. A decrease in the cure rate of Helicobacter pylori infection after treatment with the first-line regimen has been reported in various areas of the world as a result of high antibiotic resistance [1]. H. pylori treatment strongly recommended tailoring treatment guided by antibiotic susceptibility testing results [2]. It aimed to increase the success rate and decrease the antibiotic resistance status worldwide, but eradication failures were still reported in several studies [3,4]. These data suggested that there was a gap in clarifying the mechanism of antibiotic resistance. Understanding the mechanisms of antibiotic resistance can contribute to effective eradication and control of H. pylori infection
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