Primary Antibiotic Resistance Research Articles

Updating Primary Antibiotic Resistance in Helicobacter pylori Strains Isolated in Italy.

Bacterial resistance toward the most used antibiotics is increasing in Helicobacter pylori (H. pylori) strains worldwide. The emergence of multidrug resistance significantly affects the efficacy of standard therapy regimens. Therefore, this prospective study has updated the prevalence rates of primary antibiotic resistance in H. pylori strains isolated in routine practice. H. pylori isolates obtained from patients consecutively observed in a single center were tested for primary resistance by using the E-test method. The minimum inhibitory concentration (MIC) breakpoints to define resistance to clarithromycin, metronidazole, and levofloxacin were, respectively, greater than 0. 25 mg/L, 8 mg/L, and 1 mg/L, according to updated EUCAST recommendations. The trend of antibiotic prevalence, either single or combined, during 2020-2023 was assessed. A total of 789 patients meeting inclusion criteria were diagnosed with H. pylori infection, but bacterial strains were overall recovered in 632 (80.1%) cases. At bacterial culture, primary resistance rate was 36.7% for clarithromycin, 32.8% for metronidazole, and 22.1% for levofloxacin, whilst dual clarithromycin-metronidazole resistance rate was detected in 17.4%, and triple resistance in 9%. Our data found that primary resistance towards both clarithromycin and metronidazole, as well as dual resistance, is substantially stable in Italy whilst the prevalence of levofloxacin resistance seems to be decreasing in our geographic area.

Antibiotic resistance of Helicobacter pylori in Mainland China: A focus on geographic differences through systematic review and meta-analysis

BackgroundEmpirical treatment needs to be supported by regional data, but knowledge of interregional differences is currently lacking in China. This study aimed to summarize and map the primary and secondary antibiotic resistance of H. pylori in different regions of mainland China. MethodsPubMed, EMBASE, Web of Science, China National Knowledge Infrastructure and Wanfang databases were systematically reviewed for studies published between January 1st, 2000 and July 15th, 2023. Data related to primary and secondary H. pylori antibiotic resistance rates were included. Random-effects models were used to synthesize the pooled resistance rates. ResultsUltimately, 74 studies were included in the final analysis. Sixteen provinces reported resistance data. The overall resistance rates of H. pylori in mainland China were 30.72% (95% CI 27.53%–33.99%) to clarithromycin, 70.14% (95% CI 29.53%–37.46%) to metronidazole, and 32.98% (95% CI 28.73%–37.37%) to levofloxacin; for amoxicillin, tetracycline, and furazolidone, the rates were 2.41% (95% CI 1.43%–3.60%), 2.53% (95% CI 1.19%–4.28%) and 1.54% (95% CI 0.28%–3.62%), respectively. Spatial and temporal differences were observed. The resistance rates increased after treatment failure, however, secondary resistance to amoxicillin, tetracycline, and furazolidone were still low across the vast majority of study regions. ConclusionSurveillance of the updated prevalence of antibiotic resistance of H. pylori for different regions is warranted, which should factor into clinical decision making and guideline recommendations.

Comparison of Chinese medicine additives for antibiotic resistance risks in the Wuding chickens under high stocking density: Advantages and drawbacks

Traditional Chinese medicines (TCMs) with anti-pathogenic properties have been increasingly utilized in animal husbandry as substitutes for antibiotics. However, lingering uncertainties persist regarding the mobility, bacterial hosts, and potential human hazards associated with antibiotic resistance genes (ARGs) in animal husbandry when TCMs are introduced. In this study, cecal digesta from Wuding chickens subjected to varying stocking densities (moderate and high) and treated with different TCMs (dihydroartemisinin, berberine hydrochloride, and oligomeric proanthocyanidins) were collected and subjected to metagenomics-based analysis. A total of 280 ARG subtypes were identified, with multidrug and aminoglycoside resistance genes being the most diverse and abundant. The primary antibiotic resistance bacteria identified belonged to the phyla of Firmicutes (38.68%), Bacteroidetes (22.74%), and Proteobacteria (12.71%); however, some pathogenic antibiotic-resistant bacteria (PARB) were also identified across different samples. Surprisingly, high stocking density was not observed to propagate ARGs, which could be due to the restricted usage of antibiotics. Furthermore, higher proportions of mobile genetic elements and some multidrug-resistant PARB (∼4 times) were observed in high-stocking-density chickens fed berberine hydrochloride than in high-stocking-density chickens fed other TCMs, which could facilitate the horizontal gene transfer (HGT) of ARGs and pose potential human health risks. In contrast, dihydroartemisinin reduced the total abundance of ARGs and the resistome risks to human health (∼10% decrease compared to control). Moreover, rank I ARGs with higher human health risk and the risk index based on ARG risk also ranked lowest (p < 0.05) in high-stocking-density chickens fed dihydroartemisinin. The reduction effect of dihydroartemisinin was achieved by regulating the cecal microbiome of broilers and inhibiting HGT (reducing the contribution from 17.7% to 4.0%). This study provides metagenomic evidence of the development of ARGs in broiler breeding environments. The findings highlight the distinct characteristics of TCMs as feed additives on regulating the antibiotic resistome during broiler farming and demonstrate dihydroartemisinin as an effective additive complying with the environmental safety.

Antibiotic resistance in Helicobacter pylori among children and adolescents in East Asia: A systematic review and meta-analysis.

In East Asia, Helicobacter pylori ( H. pylori ) infection and related diseases are common, primarily during childhood and adolescence. The rates of primary antibiotic resistance in H. pylori among East Asian children and adolescents have not been extensively explored; few relevant systematic reviews or meta-analyses have been conducted. We evaluated the rates of antibiotic resistance in H. pylori among East Asian children and adolescents, with the goal of facilitating individualized treatment recommendations. We searched PubMed, Embase, and the Cochrane Library for studies in any language published up to February 2023 that explored antibiotic resistance in H. pylori among East Asian children and adolescents. We used MeSH and non-MeSH terms related to the topic, including terms related to children, adolescents, antibiotic resistance, H. pylori , and nations or regions. Additionally, we reviewed the reference lists of relevant articles. Studies that matched our strict predefined eligibility criteria were included in the screening process. Using established assessment methods, we evaluated the quality of the included studies. We identified 15 observational studies involving 4831 H. pylori isolates, all published between 2001 and 2022. There was substantial primary antibiotic resistance in H. pylori isolates from East Asian children and adolescents. The rates of primary resistance were 51% (95% confidence interval [CI]: 40-62%) for metronidazole; 37% (95% CI: 20-53%) for clarithromycin; 19% (95% CI: 11-28%) for levofloxacin; and less than 3% each for amoxicillin, tetracycline, and furazolidone. Subgroup analysis revealed a prominent increase in metronidazole resistance over time. Clarithromycin and levofloxacin resistance rates fluctuated between 2005 and 2015, then remained stable; other antibiotic resistance rates were generally stable. Metronidazole, clarithromycin, and levofloxacin resistance rates were significantly higher in the Chinese mainland than in other East Asian regions. The rates of dual and multiple antibiotic resistance were 28% (95% CI: 21-36%) and 10% (95% CI: 7-14%), highlighting the potential for diverse resistance patterns. H. pylori isolates from East Asian children and adolescents exhibit high levels of metronidazole and clarithromycin resistance, particularly in the Chinese mainland. The non-negligible rates of dual and multiple resistance highlight the complexity of this problem. PROSPERO, No. CRD42023402510.

Mechanisms of total phosphorus removal and reduction of β-lactam antibiotic resistance genes by exogenous fungal combination activated sludge

This study utilized Trichoderma and activated sludge to construct combined activated sludge (TAS). The metagenomic approach was employed to examine the shifts in microbial community structure and function of TAS under amoxicillin stress and investigate the mechanism underlying the reduction of β-lactam antibiotic resistance genes (β-ARGs). The findings demonstrated that the elevated aundance of glpa, glpd, ugpq, glpq, and glpb were primarily responsible for the reduction in total phosphorus (TP) removal by TAS. The increased abundance of Proteobacteria and Verrucomicrobia led to enhanced expression of ugpb, phnd, and phne, thereby improving the TP removal of TAS. Furthermore, antibiotic inactivation has gradually become the primary antibiotic resistance mechanism in TAS. Specifically, an increase in the abundance of OXA-309 in TAS will decrease the probability of amoxicillin accumulation in TAS. A decrease in β-ARGs diversity confirmed this. This study presents a novel approach to reducing antibiotic and ARG accumulation in sludge.

Primary antibiotic resistance of Helicobacter pylori in the Asia-Pacific region between 1990 and 2022: an updated systematic review and meta-analysis

We previously showed rising primary antibiotic resistance of Helicobacter pylori during 1990-2015 in the Asia-Pacific region. However, whether primary antibiotic resistance continues to rise is unknown. Therefore, we aimed to assess the latest prevalence of H pylori antibiotic resistance in this region. We did an updated systematic review and meta-analysis of observational studies and randomised controlled trials published in PubMed, Embase, and Cochrane Library between Jan 1, 1990, and July 12, 2023. Studies investigating primary H pylori resistance to clarithromycin, metronidazole, levofloxacin, amoxicillin, or tetracycline in individuals naive to eradication therapy in the Asia-Pacific region (as defined by the UN geoscheme) were eligible for inclusion. There were no language restrictions. Studies that focused on specific subpopulations (eg, children) were excluded. Using a standardised extraction form, two authors independently reviewed and extracted summary data from all eligible articles. The updated prevalence of antibiotic resistance was generated by meta-analysis under a random-effects model and subgroup analyses were done by countries and periods of study. Between-study variability was assessed by use of I2. The study is registered in PROSPERO, CRD42022339956. A total of 351 studies, including 175 new studies and 176 studies from our previous analysis, were included in this meta-analysis. The overall prevalence of primary antibiotic resistance of H pylori between 1990 and 2022 was 22% (95% CI 20-23; I2=96%) for clarithromycin, 52% (49-55; I2=99%) for metronidazole, 26% (24-29; I2=96%) for levofloxacin, 4% (3-5; I2=95%) for tetracycline, and 4% (3-5; I2=95%) for amoxicillin. Prevalence varied considerably between countries and across study periods. From 1990 to 2022, the prevalence of primary resistance increased for clarithromycin, metronidazole, and levofloxacin but remained stable for amoxicillin and tetracycline. The latest primary resistance prevalences were 30% (95% CI 28-33; I2=93%) for clarithromycin, 61% (55-66; I2=99%) for metronidazole, 35% (31-39; I2=95%) for levofloxacin, 4% (2-6; I2=96%) for tetracycline, and 6% (4-8; I2=96%) for amoxicillin in the Asia-Pacific region. Treatment guidelines should be adapted in response to the rising primary resistance of key antibiotics for H pylori eradication. A global policy to control and monitor the antibiotic resistance of H pylori is urgently needed. Ministry of Health and Welfare of Taiwan, National Science and Technology Council of Taiwan, and National Taiwan University. For the Chinese translation of the abstract see Supplementary Materials section.

Mobile genetic elements facilitate the transmission of antibiotic resistance genes in multidrug-resistant Enterobacteriaceae from duck farms

Multidrug-resistant (MDR) Enterobacteriaceae critically threaten duck farming and public health. The phenotypes, genotypes, and associated mobile genetic elements (MGEs) of MDR Enterobacteriaceae isolated from 6 duck farms in Zhejiang Province, China, were investigated. A total of 215 isolates were identified as Escherichia coli (64.65 %), Klebsiella pneumoniae (12.09 %), Proteus mirabilis (10.23 %), Salmonella (8.84 %), and Enterobacter cloacae (4.19 %). Meanwhile, all isolates were resistant to at least two antibiotics. Most isolates carried tet(A) (85.12 %), blaTEM (78.60 %) and sul1 (67.44 %) resistance genes. Gene co-occurrence analysis showed that the resistance genes were associated with IS26 and integrons. A conjugative IncFII plasmid pSDM004 containing all the above MGEs was detected in Proteus mirabilis isolate SDM004. This isolate was resistant to 18 antibiotics and carried the blaNDM-5 gene. MGEs, especially plasmids, are the primary antibiotic resistance gene (ARG) transmission route in duck farms. These findings provide a theoretical basis for the rational use of antibiotics in farms which are substantial for evaluating public health and food safety.

Primary antibiotic resistance in Helicobacter pylori in China: a systematic review and meta-analysis

The incidence of Helicobacter pylori (HP) is 25-50% in developed countries and 80% in developing countries, including 56.2% in China. However, antibiotic resistance of HP is a threat to HP control. The purpose of this study was to comprehensively evaluate primary drug resistance of HP in China. The full text of reports of the primary antibiotic resistance prevalence of HP was obtained from multiple databases (PubMed, Web of Science, Evimed, Cochrane Library, and China National Knowledge Internet). Review Manager 5.2 was adopted for meta-analysis, sensitivity analysis, and bias analysis. The Newcastle-Ottawa Scale was used to assess the article quality. In total, 38804 HP samples from 22 trials were extracted. The results suggested that the overall prevalence of amoxicillin, clarithromycin, metronidazole, and levofloxacin resistance among HP in adults was as follows: mean difference (MD)=1.35%, 95% confidence interval (CI) [1.03%, 1.68%]; MD=23.76%, 95% CI [20.23%, 27.3%]; MD=69.32%, 95% CI [64.85%, 73.8%]; and MD=29.45%, 95% CI [4.90, 176.96], respectively. From the results of sensitivity and publication bias, we find that these results are robust and had little publication bias. Our research showed that in China, the prevalence of HP resistance to primary antibiotics warrants attention, especially with regard to metronidazole, levofloxacin, and clarithromycin.

The problem of formation of new risks of medicinal resistance of patients with tuberculosis in condition of active use of antibiotics by population under COVID-19

In pandemic conditions, situation of active and uncontrolled use by population of antimicrobial preparations treating COVID-19 occurs. So, new risks of development of medication resistance among patients with various infectious diseases, tuberculosis included, appear. The purpose of the study is to characterize prevalence of antimicrobial preparations use by population in relationship with development of medication resistance in patients with tuberculosis during COVID-19 pandemic. Material and methods. The analysis of sales of antimicrobial medicines was implemented on the basis of published official data from the joint-stock company DSM Group presenting monthly audit of the Russian pharmaceutical market. The determination of primary antibiotic resistance was carried out in 2018-2020 on 3312 patients with tuberculosis. The modified method of proportions on liquid nutrient medium in system with automated accounting of microorganisms growth, the method of absolute concentrations and the method of polymerase chain reaction with real-time detection were applied. The results of the study. It was established that the most demanding antimicrobial medications among population were ceftriaxone, azithromycin, levofloxacin, moxifloxacin, azithromycin. At the same time, the maximum increase in sales in 2020 up to 150% as compared with of 2019 was determined in medications derived from quinolone moxifloxacin, levofloxacin, which began to be used in treatment of coronavirus infection. At the same time, these medications are traditionally used in tuberculosis treatment. But in 2020, alarming trend was established that limits treatment of tuberculosis patients. The primary resistance of mycobacteria was also established in newly diagnosed tuberculosis patients, also for the same antimicrobial medications of quinolone derivatives, and increasing in proportion of patients with primary medication resistance to levofloxacin, moxifloxacin in 2020 as compared to 2018 was 189-480%. At the same time, increasing of resistance to other antibiotics made up to 60.8% on average. Conclusion. The study results imply alarming scenario of medication resistance shifts towards very virulent and highly medication-resistant genotypes. This trend can result in conditions of successful transmission of deadly medication-resistant mutants that can seriously undermine effectiveness of implemented programs of struggle with tuberculosis worldwide.

Efficacy and safety of high-dose esomeprazole-amoxicillin dual therapy for Helicobacter pylori rescue treatment: a multicenter, prospective, randomized, controlled trial.

Background:High-dose dual therapy (HDDT) with proton pump inhibitors (PPIs) and amoxicillin has attracted widespread attention due to its favorable efficacy in eradicating Helicobacter pylori (H. pylori). This study aimed to compare the efficacy and safety of high-dose PPI–amoxicillin dual therapy and bismuth-containing quadruple therapy for H. pylori rescue treatment.Methods:This was a prospective, randomized, multicenter, non-inferiority trial. Patients recruited from eight centers who had failed previous treatment were randomly (1:1) allocated to two eradication groups: HDDT (esomeprazole 40 mg and amoxicillin 1000 mg three times daily; the HDDT group) and bismuth-containing quadruple therapy (esomeprazole 40 mg, bismuth potassium citrate 220 mg, and furazolidone 100 mg twice daily, combined with tetracycline 500 mg three times daily; the tetracycline, furazolidone, esomeprazole, and bismuth [TFEB] group) for 14 days. The primary endpoint was the H. pylori eradication rate. The secondary endpoints were adverse effects, symptom improvement rates, and patient compliance.Results:A total of 658 patients who met the criteria were enrolled in this study. The HDDT group achieved eradication rates of 75.4% (248/329), 81.0% (248/306), and 81.3% (248/305) asdetermined by the intention-to-treat (ITT), modified intention-to-treat (MITT), and per-protocol (PP) analyses, respectively. The eradication rates were similar to those in the TFEB group: 78.1% (257/329), 84.2% (257/305), and 85.1% (257/302). The lower 95% confidence interval boundary (−9.19% in the ITT analysis, − 9.21% in the MITT analysis, and −9.73% in the PP analysis) was greater than the predefined non-inferiority margin of −10%, establishing a non-inferiority of the HDDT group vs. the TFEB group. The incidence of adverse events in the HDDT group was significantly lower than that in the TFEB group (11.1% vs. 26.8%, P < 0.001). Symptom improvement rates and patients’ compliance were similar between the two groups.Conclusions:Fourteen-day HDDT is non-inferior to bismuth-containing quadruple therapy, with fewer adverse effects and good treatment compliance, suggesting HDDT as an alternative for H. pylori rescue treatment in the local region.Trial registration:Clinicaltrials.gov, NCT04678492.

Primary Antibiotic Resistance of Helicobacter pylori in Different Regions of China: A Systematic Review and Meta-Analysis.

Aim: Understanding the prevalence of antibiotic resistance can provide reliable information for selecting treatment options. The goal of this meta-analysis was to observe the primary antibiotic resistance of Helicobacter pylori (H. pylori) in different regions and time periods of China. Method: We searched PubMed, EMBASE, Chinese Biomedical databases and the China National Knowledge Infrastructure from inception to 20 February 2022. Data on the prevalence of H. pylori primary resistance at various time points were included. A random-effect model was established to calculate the pooled antibiotic resistance. Results: In total, 2150 articles were searched, with 70 meeting the inclusion criteria. The resistance to clarithromycin, metronidazole, levofloxacin amoxicillin, tetracycline and furazolidone in 2016–2020 were 34% (95% CI: 30–39%), 78% (95% CI: 73–84%), 35% (95% CI: 30–40%), 3% (95% CI: 1–5%), 2% (95%CI: 1–4%) and 1% (95% CI: 0–4%), respectively. Clarithromycin showed regional difference, as the resistance was higher in northern (37%, 95% CI: 32–41%) and western China (35%, 95% CI: 17–54%) than that in southern (24%, 95% CI: 17–32%) and eastern China (24%, 95% CI: 20–28%). Conclusion: The resistance of H. pylori to clarithromycin and metronidazole was high and increased over time, whereas resistance to levofloxacin, amoxicillin, tetracycline and furazolidone remained stable.

Changing profile of Helicobacter pylori primary antibiotic resistance in Singapore over two decades.

Antibiotic resistance is a key reason for Helicobacter pylori (H. pylori) treatment failure and updated local data are important to guide the choice of empiric first-line therapy. Clarithromycin-based triple therapy (TT) is currently the first-line treatment in Singapore. Our primary aim was to determine the change in pattern of primary antibiotic resistance of H. pylori in Singapore as well as TT success rate. A registry of H. pylori isolates was tested for primary antibiotic resistance and were analyzed from year 2001 to 2020. Treatment outcome data based on 13C-urea breath test (13C-UBT) results of empiric first-line 2-week TT from 2019 to 2020 were also analyzed retrospectively. A total of 387 H. pylori isolates were included. Rates of resistance to clarithromycin as well as tetracycline showed a downtrend in the last 5 years (clarithromycin: 2001-2002: 8.57%; 2007-2008: 14.14%; 2013-2014: 18.09%; 2019-2020: 13.71%; tetracycline: 2001-2002: 5.71%; 2007-2008: 7.07%; 2013-2014: 7.45%; 2019-2020: 0%). The resistance rate for amoxicillin remained low (2001-2002: 2.86%; 2007-2008: 5.05%; 2013-2014: 4.26%; 2019-2020: 7.26%). There was a steady increase in the rate of levofloxacin resistance (2001-2002: 5.71%; 2007-2008: 11.11%; 2013-2014: 15.96%; 2019-2020: 16.94%). From 2019 to 2020, the rate of successful TT was 91.67% (891/972). The latest rate of clarithromycin resistance in 2019 to 2020 remained below the threshold of 15% and eradication rates remain high; thus, TT remains appropriate as an empiric first-line treatment in Singapore.

Culture-based antibiotic susceptibility testing for Helicobacter pylori infection: a systematic review

BackgroundPrimary antibiotic resistance in Helicobacter pylori (H. pylori) strains is increasing worldwide, affecting therapy success. The use of therapies tailored on susceptibility pre-testing at culture has been proposed, but data are still conflicting.MethodWe performed a systematic review to evaluate the role of a culture-based therapeutic approach for H. pylori treatment, taking into account the sensitivity of culture and the success rates achieved with tailored therapies in different therapeutic steps.ResultsWe analyzed data from 51 studies. Overall, H. pylori strains were isolated in 80.7% of 7889 patients, the success rates being 78.1%, 77.5%, 86.3% and 86.6%, before first-, second-, third-line or more therapies, respectively. In comparative studies, the infection was cured in 89.9% of 2052 patients treated with tailored therapies, and in 77.6% of 2516 patients receiving empiric therapy (P<0.001). However, in the subanalysis, the tailored approach achieved optimal eradication rates (>90%) only when it was applied before first- and second-line therapies, but not before third-line or more attempts (<80%). Moreover, no significant difference emerged between the 2 approaches when data from only the most recent (last 5 years) studies were considered, as well as in those performed in Western populations.ConclusionsThe attempt to achieve antibiotic susceptibility testing before treatment failed in 20% of infected patients managed in dedicated laboratories. Culture-tailored therapies administered after 2 or more therapies achieved suboptimal eradication rates. The role of bacterial culture in patients whose therapeutic management failed to eradicate H. pylori probably needs to be corroborated by further data.

Species-Level Analysis of the Human Gut Microbiome Shows Antibiotic Resistance Genes Associated With Colorectal Cancer.

Colorectal cancer (CRC) is the second leading cause of cancer deaths and continuously increases new cancer cases globally. Accumulating evidence links risks of CRC to antibiotic use. Long-term use and abuse of antibiotics increase the resistance of the gut microbiota; however, whether CRC is associated with antibiotic resistance in gut microbiota is still unclear. In this study, we performed a de novo assembly to metagenomic sequences in 382 CRC patients and 387 healthy controls to obtain representative species-level genome bins (rSGBs) and plasmids and analyzed the abundance variation of species and antibiotic resistance genes (ARGs). Twenty-five species and 65 ARGs were significantly enriched in the CRC patients, and among these ARGs, 12 were multidrug-resistant genes (MRGs), which mainly included acrB, TolC, marA, H-NS, Escherichia coli acrR mutation, and AcrS. These MRGs could confer resistance to fluoroquinolones, tetracyclines, cephalosporins, and rifamycin antibiotics by antibiotic efflux and inactivation. A classification model was built using the abundance of species and ARGs and achieved areas under the curve of 0.831 and 0.715, respectively. Our investigation has identified the antibiotic resistance types of ARGs and suggested that E. coli is the primary antibiotic resistance reservoir of ARGs in CRC patients, providing valuable evidence for selecting appropriate antibiotics in the CRC treatment.

The Emergence of Multidrug-Resistant Helicobacter pylori in Southeast Asia: A Systematic Review on the Trends and Intervention Strategies Using Antimicrobial Peptides.

The emergence of multidrug-resistant H. pylori poses a public healthcare threat, particularly in low- and middle-income countries. Recently, the World Health Organization has classified clarithromycin-resistant H. pylori as high priority in the research and discovery of novel antibiotics. This study was aimed to systematically review the prevalence of primary antibiotic resistance in H. pylori in Southeast Asian countries (SEAC) and to review current studies of antimicrobial peptides against H. pylori. We systematically searched through electronic databases of studies conducted on antimicrobial resistance of H. pylori in SEA countries. Furthermore, we searched articles that conducted studies on antimicrobial peptides, naturally occurring host’s defense molecules, against H. pylori. After a series of screening processes, 15 studies were included in our systematic review. Our analysis revealed that primary resistance of H. pylori to metronidazole, clarithromycin, and levofloxacin were high in SEAC, although the primary resistance to amoxicillin and tetracycline remains low. Multidrug-resistant H. pylori are emerging in SE Asian countries. The antimicrobial peptides show promising antibacterial and antibiofilm activity against drug-resistant H. pylori. The research and discovery of antimicrobial peptides against H. pylori in SEAC will help in limiting the spread of antimicrobial resistance of H. pylori.

Can financial rewards for stewardship in primary care curb antibiotic resistance?

Antibiotic use in primary care remains highly frequent, variable, and is often unnecessary. Hence, in principle, effective outpatient antibiotic stewardship might be an impactful intervention. Countries such as the Netherlands and Sweden where antibiotic stewardship has been applied in the outpatient setting also have some of the lowest rates of antibiotic resistance in Europe. However, for a variety of reasons, antibiotic stewardship in primary care has been challenging in most other world regions.

Etiological role of opportunistic microflora in the pathogenesis of implant-associated inflammation after primary total knee replacement

Objective: to investigate etiological role of opportunistic microflora in the pathogenesis of implant-associated inflammation in patients after primary knee replacement and antibiotic resistance of major infectious agent groups. Material and Methods. We conducted the retrospective analysis of microbiological samples from 383 patients with postoperative implant-associated inflammation after the primary total knee arthroplasty. Results. Gram-positive cocci (63.5%) are the leading agents of implant-associated inflammation. We also noted an increase in the etiological role of coagulase-positive staphylococci. Among the Gram-negative group, Enterobacteriaceae and non-fermenting bacteria were major agents. We revealed high resistance of Staphylococcus spp. to antibiotics of various groups, among which oxazolidinones and glycylcyclines were the most active. Gram-negative bacteria exhibited high resistance to cephalosporine and macrolides, whereas carbapenems and fluoroquinolones worked best. Conclusion. Gram-negative Enterobacteriaceae, non-fermenters, and Gram-positive cocci are the most significant etiological factors in the pathogenesis of implant-associated inflammation in patients after primary total knee arthroplasty.

Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community

ObjectiveOur aim was to prospectively assess the antibiotic resistance rates in Helicobacter pylori strains in Europe in 2018 and to study the link between antibiotic consumption in the community and...

Antibiotic resistance of Helicobacter pylori in the European part of the Russian Federation: first results

Determine the primary antibiotic resistance of Helicobacter pylori (H. pylori) strains isolated from patients living in the European part of the Russian Federation. As part of a clinical laboratory study, from 2015 to 2018, 27 gastrobiopsy samples obtained from H. pylori-infected patients were analyzed. H. pylori infection was verified using a rapid urease test or a 13C-urea breath test. The values of the minimum inhibitory concentration (MIC) of antibiotics were determined by the diffusion method using E-test strips (BioMerieux, France) according to the recommendations of the manufacturer. The sensitivity of the isolates was determined for 6 antibacterial drugs (amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, rifampicin). According to the data obtained, resistance to amoxicillin was 0%, clarithromycin 11.1%, metronidazole 59.3%, levofloxacin 3.7%, tetracycline 0%, and rifampicin 14.8%. Dual resistance to clarithromycin and metronidazole was recorded in two isolates (7.4%). Thus, the first results of the evaluation of H. pylori antibiotic resistance in the European part of the Russian Federation indicate a low resistance of the microorganism to clarithromycin and quite high to metronidazole.

Primary antibiotic resistance of Helicobacter pylori among a Chinese Tibetan population.

Aim: To evaluate the primary antibiotic resistance in Helicobacter pylori strains isolated from a Chinese Tibetan population. Methods & materials: Gastric biopsies from 400 H.pylori treatment-naive Tibetan patients were collected for H.pylori isolation.Susceptibility to amoxicillin (AML)/clarithromycin (CLR)/levofloxacin (LEV)/metronidazole (MTZ)/tetracycline (TET)/rifampicin (RIF)/furazolidone (FZD)was determined by E-test or a disk diffusion assay. Results: Biopsies from 117 patients were H. pylori culture positive (29.3%). The primary resistance rates to MTZ, CLR, LEV, RIF, AML, TET and FZD were 90.6, 44.4, 28.2, 69.2, 7.7, 0.8and 0.8%, respectively. Interestingly, 42.7% of the strains had simultaneous resistance to CLR and MTZ. Conclusion: Among Tibetan strains, primary resistance rates were high for CLR/MTZ/LEV, whereas primary resistance rates to AML/TET/FZD were low. The high resistance to RIF is a concerning finding.