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JAC Advance Access published online on July 8, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh343
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received February 19, 2004
Revised May 27, 2004
Accepted May 29, 2004

Original article

Helicobacter pylori antibiotic resistance patterns and genotypes in adult dyspeptic patients from a regional population in North Wales

Nicola C. Elviss 1, Robert J. Owen 1*, Jacqueline Xerry 1, A. Mark Walker 2, Kenneth Davies 2

1 Laboratory of Enteric Pathogens, Health Protection Agency, Specialist and Reference Microbiology Division, 61 Colindale Avenue, London NW9 5HT, UK
2 National Public Health Service, Bangor, Gwynedd LL57 2PW, Wales, UK

* To whom correspondence should be addressed. E-mail: Robert.Owen{at}hpa.org.uk.


  Abstract

Objective: Surveillance data on Helicobacter pylori antibiotic susceptibilities in Wales are limited, despite resistance being a key factor in treatment failure. A single-centre survey was undertaken over 3 years to determine local antibiotic resistance rates on isolates from dyspeptic patients in Bangor, Gwynedd (North Wales).

Methods: Susceptibilities were determined for 363 isolates by disc diffusion and the Etest. Isolates were also genotyped (cagA presence and vacA allelic types).

Results: Overall in vitro resistance rates were 24% for metronidazole and 7% for clarithromycin, with 4% resistant to both antibiotics. Resistant strains typically had high MICs of >256 mg/L. Tetracycline resistance was identified in only one isolate whereas no isolates showed resistance to amoxicillin. There was a two-fold increase in resistance over the study period. No gender and age associations with resistance were detected. Resistant and susceptible isolates were genotypically diverse with respect to cagA/vacA type but the vacA s1m2 form was a feature of all clarithromycin-resistant isolates compared with 56% of the susceptible isolates.

Conclusion: Although the overall antibiotic resistance rates of H. pylori from North Wales were low compared with many other regions in Europe, continued surveillance, particularly of high-level resistance (MIC >256 mg/L), is recommended to monitor the effects of the ‘test and treat’ strategy for H. pylori eradication.

Keywords: clarithromycin; metronidazole; dual resistance; surveillance.
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