Aim To evaluate Helicobacter pylori (H. pylori) resistance to clarithromycin and quinolones in patients with dyspepsia in Tuzla Canton, Bosnia and Herzegovina, a region with no data on clarithromycin or quinolones resistance. Methods A prospective cross-sectional study was conducted at the Department of Gastroenterology and Hepatology at University Clinical Centre Tuzla between January 2021 and June 2022. The study included 99 patients who underwent esophagogastroduodenoscopy (EGDS) due to dyspepsia. In all patients biopsies were taken for rapid urease test (RUT) and histology findings, concomitantly with blood samples for IgG serology. All RUT positive patient samples were tested for clarithromycin and quinolones susceptibility with GenoType HelicoDr, a PCR method which detects point mutations in 23S rRNA and mutations in the gyrA gene. Results Out of 99 dyspeptic patients, 67 (67.7%) were serologically positive to H. pylori, 46 (46.4.%) were RUT positive, and 19 (19.2 %) had a positive histology finding. Antibiotic (AB) resistance was tested in the total of 46/99 (46.4%) patients. Resistance to clarithromycin was detected in 28.26% (13/46), quinolones resistance in 36.96% (17/46) , and resistance to both AB was detected in 8.69% (4/46) tested biopsies. Conclusions Due to high clarithromycin and quinolones resistance rates, we recommend the use of bismuth quadruple or non-bismuth concomitant quadruple therapy for H. pylori eradication in Tuzla Canton, Bosnia and Herzegovina.
Elbehiry A, Marzouk E, Aldubaib M, Abalkhail A, Anagreyyah S, Anajirih N, et al. Helicobacter pylori infection: current status and future prospects on diagnostic, therapeutic and control challenges. Antibiotics. 2023. p. 191.
2.
Malfertheiner P, Megraud F, Rokkas T, Gisbert J, Liou J, Schulz C, et al. European Helicobacter and Microbiota Study group. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022. p. 2022–327745.
3.
Khoder G, Muhammad J, Mahmoud I, Soliman S, Burucoa C. Prevalence of Helicobacter pylori and its associated factors among healthy asymptomatic residents in the United Arab Emirates. Pathogens. 2019. p. 44.
4.
Schistosomes, Liver Flukes and Helicobacter pylori. 1994.
5.
Savoldi A, Carrara E, Graham D, Conti M, Tacconelli E. Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization Regions. Gastroenterology. 2018. p. 1372–82.
6.
Kocsmár É, Buzás G, Szirtes I, Kocsmár I, Kramer Z, Szijártó A, et al. Primary and secondary clarithromycin resistance in Helicobacter pylori and mathematical modeling of the role of macrolides. Nat Commun. 2021. p. 2255.
7.
Lauener F, Imkamp F, Lehours P, Buissonnière A, Benejat L, Zbinden R, et al. Genetic determinants and prediction of antibiotic resistance phenotypes in Helicobacter pylori. J Clin Med. 2019. p. 53.
8.
Hu Y, Zhu Y, Lu N. Novel and effective therapeutic regimens for Helicobacter pylori in an era of increasing antibiotic resistance. Front Cell Infect Microbiol. 2017. p. 168.
9.
Pastukh N, Binyamin D, On A, Paritsky M, Peretz A. Geno Type HelicoDR test in comparison with histology and culture for Helicobacter pylori detection and identification of resistance mutations to clarithromycin and fluoroquinolones. Helicobacter. 2017. p. 226.
10.
Kocsmár É, Szirtes I, Kramer Z, Szijártó A, Bene L, Buzás G, et al. Sensitivity of Helicobacter pylori detection by Giemsa staining is poor in comparison with immunohistochemistry and fluorescent in situ hybridization and strongly depends on inflammatory activity. Helicobacter. 2017. p. 101–11.
11.
Rokkas T, Gisbert J, Malfertheiner P, Niv Y, Gasbarrini A, Leja M, et al. Comparative effectiveness of multiple different first-line treatment regimens for Helicobacter pylori infection: a network meta-analysis. Gastroenterology. 2021. p. 495–507.
12.
Hauser G, Salkic N, Vukelic K, Knez J, Stimac A, D. Probiotics for standard triple Helicobacter pylori eradication: a randomized, double-blind, placebo-controlled trial. Medicine (Baltimore). 2015. p. 685.
13.
Ierardi E, Giorgio F, Losurdo G, Leo D, Principi A, M. How antibiotic resistances could change Helicobacter pylori treatment: A matter of geography? World J Gastroenterol. 2013. p. 8168–80.
14.
Karvelas A, Martinez-Gonzalez B, Papadopoulos V, Panopoulou M, Sgouras D, Mimidis K. Realtime PCR detection of Helicobacter pylori clarithromycin resistance in Thrace. Hippokratia. 2021. p. 51–5.
15.
Akar M, Aydın F, Kayman T, Abay S, Karakaya E. Detection of Helicobacter pylori by invasive tests in adult dyspeptic patients and antibacterial resistance to six antibiotics, including rifampicin in Turkey. Is clarithromycin resistance rate decreasing? Turk J Med Sci. 2021. p. 1445–64.
16.
Boyanova L, Hadzhiyski P, Markovska R, Gergova R. Investigation of multidrug-resistant Helicobacter pylori in pediatric patients: a Bulgarian study and literature data. Acta Microbiol Immunol Hung. 2022. p. 41–5.
17.
Milivojevic V, Babic I, Kekic D, Rankovic I, Sagdati S, Panic N, et al. Current trends in the management of Helicobacter pylori infection in Serbia: preliminary results from the European registry on H. pylori management (Hp-EuReg). Dig Dis. 2022. p. 377–86.
18.
Tonkic A, Tonkic M, Brnic D, Novak A, Puljiz Z, Simunic M. Time trends of primary antibiotic resistance of Helicobacter pylori isolates in Southern Croatia. J Chemother. 2012. p. 182–4.
19.
Megraud F, Bruyndonckx R, Coenen S, Wittkop L, Huang T, Hoebeke M, et al. European Helicobacter pylori antimicrobial susceptibility testing Working Group. Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community. Gut. 2021. p. 1815–22.
20.
Graham D, Moss S. Antimicrobial susceptibility testing for Helicobacter pylori is now widely available: when, how, why. Am J Gastroenterol. 2022. p. 524–8.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.