Prevalence of Primary and Secondary Antimicrobial Resistance of Helicobacter pylori in Korea from 2003 through 2012

• DOI: 10.1111/hel.12031
• Publication Date: 2012-12-14T01:20:45Z
• Authors: Jung Won Lee; Nayoung Kim; Jung Mogg Kim; Ryoung Hee Nam; Hyun Chang; Jae Yeon Kim; Cheol Min Shin; Young Soo Park; Dong Ho Lee; Hyun Chae Jung
• Keywords: Adult; Male; Helicobacter pylori; Microbial Sensitivity Tests; Middle Aged; Anti-Bacterial Agents; Helicobacter Infections; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Drug Resistance, Multiple, Bacterial; Drug Resistance, Bacterial; Republic of Korea; Prevalence; Humans; Female; Aged

BackgroundAntimicrobial resistance of Helicobacter pylori (H. pylori) affects the efficacy of eradication therapy. The aim of this study was to estimate the prevalence of primary and secondary resistance of H. pylori isolates to antibiotics and to characterize the risk factors associated with antimicrobial resistance in Korea.Materials and MethodsThis study was performed during the period of 2003–2012. Primary resistance was evaluated from 347 patients without any history of eradication, and secondary resistance was evaluated in 86 patients from whom H. pylori was cultured after failure of eradication. Minimal inhibitory concentration test was performed for amoxicillin, clarithromycin, metronidazole, tetracycline, azithromycin, levofloxacin, and moxifloxacin using agar dilution method. Primary and secondary resistance rates of H. pylori to 7 antibiotics were evaluated and risk factors for the antibiotic resistance were analyzed.ResultsIncrease in the primary resistance rate was found in amoxicillin (6.3–14.9%, p = .051), clarithromycin (17.2–23.7%, p = .323), and both of levofloxacin and moxifloxacin (4.7–28.1%, p = .002) during the study period. Secondary resistance rate significantly increased in metronidazole, levofloxacin, and moxifloxacin. Increase of resistance occurred after initial failure of eradication therapy in case of clarithromycin (p < .001), azithromycin (p < .001), levofloxacin (p = .011), and moxifloxacin (p = .020). Multivariable analyses showed that clarithromycin, azithromycin, levofloxacin, and moxifloxacin resistance was associated with previous eradication treatment history.ConclusionsThe increased primary and secondary antibiotic resistance of H. pylori in Korea is ongoing, and it will become a significant limitation for effective eradication of H. pylori in the future.