The primary resistance of Helicobacter pylori in Taiwan after the national policy to restrict antibiotic consumption and its relation to virulence factors - A nationwide study

Jyh Ming Liou, Chi Yang Chang, Mei Jyh Chen, Chieh Chang Chen, Yu Jen Fang, Ji Yuh Lee, Jeng Yih Wu, Jiing Chyuan Luo, Tai Cherng Liou, Wen Hsiung Chang, Cheng Hao Tseng, Chun Ying Wu, Tsung Hua Yang, Chun Chao Chang, Hsiu Po Wang, Bor Shyang Sheu, Jaw Town Lin, Ming Jong Bair, Ming Shiang Wu, Chi Ming TaiChing Tai Lee, Wen Lun Wang, Yi Chia Lee, Yu Chi Wang, Gastrointestinal Disease Taiwan Gastrointestinal Disease

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Abstract

Objective: The Taiwan Government issued a policy to restrict antimicrobial usage since 2001. We aimed to assess the changes in the antibiotic consumption and the primary resistance of H. pylori after this policy and the impact of virulence factors on resistance. Methods: The defined daily dose (DDD) of antibiotics was analyzed using the Taiwan National Health Insurance (NHI) research database. H. pylori strains isolated from treatment naïve (N=1395) and failure from prior eradication therapies (N=360) from 9 hospitals between 2000 and 2012 were used for analysis. The minimum inhibitory concentration was determined by agar dilution test. Genotyping for CagA and VacA was determined by PCR method. Results: The DDD per 1000 persons per day of macrolides reduced from 1.12 in 1997 to 0.19 in 2008, whereas that of fluoroquinolones increased from 0.12 in 1997 to 0.35 in 2008. The primary resistance of amoxicillin, clarithromycin, metronidazole, and tetracycline remained as low as 2.2%, 7.9%, 23.7%, and 1.9% respectively. However, the primary levofloxacin resistance rose from 4.9% in 2000-2007 to 8.3% in 2008-2010 and 13.4% in 2011-2012 (p=0.001). The primary resistance of metronidazole was higher in females than males (33.1% vs. 18.8%, p p[ampi]lt;0.001), which was probably attributed to the higher consumption of nitroimidazole. Neither CagA nor VacA was associated with antibiotic resistance. Conclusions: The low primary clarithromycin and metronidazole resistance of H. pylori in Taiwan mightbe attributed to the reduced consumption of macrolides and nitroimidazole after the national policy to restrict antimicrobial usage. Yet, further strategies are needed to restrict the consumption of fluoroquinolones in the face of rising levofloxacin resistance.

Original languageEnglish
Article numbere0124199
JournalPLoS One
Volume10
Issue number5
DOIs
Publication statusPublished - May 5 2015

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ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Liou, J. M., Chang, C. Y., Chen, M. J., Chen, C. C., Fang, Y. J., Lee, J. Y., Wu, J. Y., Luo, J. C., Liou, T. C., Chang, W. H., Tseng, C. H., Wu, C. Y., Yang, T. H., Chang, C. C., Wang, H. P., Sheu, B. S., Lin, J. T., Bair, M. J., Wu, M. S., ... Taiwan Gastrointestinal Disease, G. D. (2015). The primary resistance of Helicobacter pylori in Taiwan after the national policy to restrict antibiotic consumption and its relation to virulence factors - A nationwide study. PLoS One, 10(5), [e0124199]. https://doi.org/10.1371/journal.pone.0124199