Abstract
Mongolia has a high prevalence of Helicobacter pylori infection and the second highest incidence of gastric cancer worldwide. Thus, investigating the prevalence of antibiotic resistance and its underlying genetic mechanism is necessary. We isolated 361 H. pylori strains throughout Mongolia. Agar dilution assays were used to determine the minimum inhibitory concentrations of five antibiotics; amoxicillin, clarithromycin, metronidazole, levofloxacin, and minocycline. The genetic determinants of antibiotic resistance were identified with next-generation sequencing (NGS) and the CLC Genomics Workbench. The resistance to metronidazole, levofloxacin, clarithromycin, amoxicillin, and minocycline was 78.7%, 41.3%, 29.9%, 11.9% and 0.28%, respectively. Multidrug resistance was identified in 51.3% of the isolates investigated which were further delineated into 9 antimicrobial resistance profiles. A number of known antibiotic resistance mutations were identified including rdxA, frxA (missense, frameshift), gyrA (N87K, A88P, D91G/N/Y), 23S rRNA (A2143G), pbp1A (N562Y), and 16S rRNA (A928C). Furthermore, we detected previously unreported mutations in pbp1A (L610*) and the 23S rRNA gene (A1410G, C1707T, A2167G, C2248T, and C2922T). The degree of antibiotic resistance was high, indicating the insufficiency of standard triple therapy in Mongolia.
Highlights
The discovery of Helicobacter pylori revolutionized pathological concepts and therapeutic approaches to upper gastrointestinal diseases
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Our present study found a high incidence (51.3%) of multidrug resistance (MDR) among H. pylori isolated in Mongolia, suggesting that minocycline may represent an important candidate as a treatment option
Summary
The discovery of Helicobacter pylori revolutionized pathological concepts and therapeutic approaches to upper gastrointestinal diseases. H. pylori, which is a major cause of chronic gastritis, peptic ulcer, mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric cancer (GC) [1,2,3] was classified as a class I carcinogen in 1994 [4]. At least 1 million new cases of GC were diagnosed in 2018, and GC is the third leading cause of cancer death worldwide [5]. Mongolia, which is bordered by Russia and China, is one of the least densely populated countries in the world. The population of Mongolia has a high prevalence (76%) of H. pylori infection [6] and 80% among dyspeptic patients [7]. The effective treatment of H. pylori infection requires eradicating the pathogen and preventing its associated diseases such as GC [2]
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