Helicobacter pylori resistance to clarithromycin and fluoroquinolones in a pediatric population in Turkey: A cross-sectional study.

Abstract

Helicobacter pylori antimicrobial resistance is gradually increasing around the world. However, there are a limited number of studies reporting on this issue in the pediatric population. In this study, we aimed to determine Hpylori resistance to clarithromycin and fluoroquinolones in the pediatric patients living in Kırıkkale province that were detected with Hpylori in gastric biopsies. Moreover, we also aimed to investigate the concordance between the histopathologic and molecular methods used in the diagnosis of Hpylori infection. Patients aged 2-18years who had a history of epigastric pain and/or nausea persisting for longer than 1month underwent upper gastrointestinal endoscopy. Biopsies were taken from the gastric antral mucosa. In the samples detected with Hpylori in the histopathologic examination, the presence of Hpylori and Hpylori resistance to clarithromycin and fluoroquinolones was investigated using the GenoType HelicoDR test which allows the detection of wild-type and mutant genes. The strains detected with more than one mutant gene are defined as hetero-resistant strains. The 93 patients that underwent DNA extraction and amplification included 68 (73.1%) girls and 25 (26.9%) boys with a median age of 15±2.62 (range 6-17) years. The overall concordance for the diagnosis of Hpylori infection between histopathology and PCR was 94%, and Hpylori resistance to clarithromycin and fluoroquinolones was 27% and 15%, respectively. The high Hpylori resistance to clarithromycin and fluoroquinolones among the pediatric patients in our region implicates that the antibiotic sensitivity of strains should be studied prior to administration in accordance with the recommendations provided in the guidelines. Moreover, the presence of hetero-resistant strains in our patients may be a reason for treatment failure.