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Three unsuccessful treatments of Helicobacter pylori infection by a highly virulent strain with quadruple antibiotic resistance

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Abstract

We report a case of an adult patient undergoing three unsuccessful Helicobacter pylori treatments, including proton pump inhibitor (PPI), bismuth subcitrate, metronidazole and tetracycline in 2012, PPI, amoxicillin and clarithromycin in 2013, and PPI, amoxicillin and rifampin in 2014. Following the first treatment, the isolate was metronidazole and ciprofloxacin/levofloxacin resistant. After the second treatment, the isolate was resistant to metronidazole, ciprofloxacin/levofloxacin and rifampin, developing secondary clarithromycin resistance by A2143G mutation and was susceptible only to tetracycline. After the third treatment, the patient still remained H. pylori positive. Patient’s strain was highly virulent (cagA +, cagE + and vacA s1a/m1/i1). The evolution of the patient’s disease was from gastroesophageal reflux disease in 2012 to two duodenal ulcers in 2015. Briefly, the infecting strain showed quadruple antibiotic resistance and a transient amoxicillin resistance. Triple clarithromycin-based treatment induced secondary clarithromycin resistance by A2143G mutation, while rifampin resistance caused the third treatment failure. Several options for the next treatment regimens are discussed.

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References

  • Barahona-Garrido J, Quiñonez NF, Cerda-Contreras E, Maria Sarti H, Téllez-Ávila FI (2013) Fosfomycin-containing second-line treatment for Helicobacter pylori infection. Am J Gastroenterol 108:858–9

    Article  CAS  PubMed  Google Scholar 

  • Boyanova L, Andreev N, Bouchard S, Megraud F (1994) Helicobacter pylori seroprevalence in Bulgaria. Med Microbiol Lett 3:107–13

  • Boyanova L, Gergova G, Nikolov R, Davidkov L, Kamburov V, Jelev C, Mitov I (2008) Prevalence and evolution of Helicobacter pylori resistance to 6 antibacterial agents over 12 years and correlation between susceptibility testing methods. Diagn Microbiol Infect Dis 60:409–15

    Article  CAS  PubMed  Google Scholar 

  • Boyanova L, Markovska R, Yordanov D, Marina M, Ivanova K, Panayotov S, Gergova G, Mitov I (2009) High prevalence of virulent Helicobacter pylori strains in symptomatic Bulgarian patients. Diagn Microbiol Infect Dis 64:374–80

    Article  PubMed  Google Scholar 

  • Brenner H, Weyermann M, Rothenbacher D (2006) Clustering of Helicobacter pylori infection in couples, differences between high- and low-prevalence population groups. Ann Epidemiol 16:516–20

    Article  PubMed  Google Scholar 

  • Cid TP, Fernández MC, Benito Martínez S, Jones NL (2013) Pathogenesis of Helicobacter pylori infection. Helicobacter 2013 Suppl 1:12–17

    Google Scholar 

  • EUCAST-The European Committee on Antimicrobial Susceptibility Testing (2015) Breakpoint tables for interpretation of MICs and zone diameters. Version 5.0, 2015. http://www.eucast.org. Accessed 01 January 2015

  • Francavilla R, Lionetti E, Castellaneta S, Margiotta M, Piscitelli D, Lorenzo L, Cavallo L, Ierardi E (2010) Clarithromycin-resistant genotypes and eradication of Helicobacter pylori. J Pediatr 157:228–32

    Article  CAS  PubMed  Google Scholar 

  • Furuta T, Soya Y, Sugimoto M, Shirai N, Nakamura A, Kodaira C, Nishino M, Okuda M, Okimoto T, Murakami K, Fujioka T, Hishida A (2007) Modified allele-specific primer-polymerase chain reaction method for analysis of susceptibility of Helicobacter pylori strains to clarithromycin. J Gastroenterol Hepatol 22:1810–5

    Article  CAS  PubMed  Google Scholar 

  • Gisbert JP, Calvet X (2012) Review article: rifabutin in the treatment of refractory Helicobacter pylori infection. Aliment Pharmacol Ther 35:209–21

    Article  CAS  PubMed  Google Scholar 

  • Papastergiou V, Georgopoulos SD, Karatapanis S (2014) Treatment of Helicobacter pylori infection: meeting the challenge of antimicrobial resistance. World J Gastroenterol 20:9898–911

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Torres J, Camorlinga-Ponce M, Pérez-Pérez G, Madrazo-De la Garza A, Dehesa M, González-Valencia G, Muñoz O (2001) Increasing multidrug resistance in Helicobacter pylori strains isolated from children and adults in Mexico. J Clin Microbiol 39:2677–80

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yang JC, Lu CW, Lin CJ (2014) Treatment of Helicobacter pylori infection: current status and future concepts. World J Gastroenterol 20:5283–93

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yordanov D, Boyanova L, Markovska R, Gergova G, Mitov I (2012) Significance of Helicobacter pylori vacA intermediate region genotyping-a Bulgarian study. Diagn Microbiol Infect Dis 74:253–7

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This research was funded by the Grant/Contract B02/17 (12.12.2014) from the National Science Fund at the Ministry of Education and Science of Bulgaria, Project Ref. B02/2 (14.07.2014) entitled “Complex study of Helicobacter pylori virulence and resistance factors and epidemiology of the infection”.

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Authors and Affiliations

  1. Department of Medical Microbiology, Medical University of Sofia, Zdrave Street 2, 1431, Sofia, Bulgaria

    Lyudmila Boyanova, Daniel Yordanov, Rumyana Markovska & Ivan Mitov

  2. Department of Gastroenterology, University Hospital St. Ekaterina, Medical University of Sofia, Sofia, Bulgaria

    Ivailo Evstatiev

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  1. Lyudmila Boyanova
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  2. Ivailo Evstatiev
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  3. Daniel Yordanov
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  4. Rumyana Markovska
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  5. Ivan Mitov
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Correspondence to Lyudmila Boyanova.

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The authors declare that they have no competing interests.

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Boyanova, L., Evstatiev, I., Yordanov, D. et al. Three unsuccessful treatments of Helicobacter pylori infection by a highly virulent strain with quadruple antibiotic resistance. Folia Microbiol 61, 307–310 (2016). https://doi.org/10.1007/s12223-015-0439-2

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  • DOI: https://doi.org/10.1007/s12223-015-0439-2

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