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

Research output: Contribution to journalArticle

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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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metronidazole
Helicobacter pylori
national surveys
Metronidazole
Virulence Factors
Taiwan
clarithromycin
nitroimidazoles
Nitroimidazoles
macrolides
Levofloxacin
fluoroquinolones
virulence
Clarithromycin
antibiotics
Fluoroquinolones
Macrolides
Anti-Bacterial Agents
anti-infective agents
Health insurance

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., ... 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

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

In: PLoS One, Vol. 10, No. 5, e0124199, 05.05.2015.

Research output: Contribution to journalArticle

Liou, JM, Chang, CY, Chen, MJ, Chen, CC, Fang, YJ, Lee, JY, Wu, JY, Luo, JC, Liou, TC, Chang, WH, Tseng, CH, Wu, CY, Yang, TH, Chang, CC, Wang, HP, Sheu, BS, Lin, JT, Bair, MJ, Wu, MS, Tai, CM, Lee, CT, Wang, WL, Lee, YC, Wang, YC & Taiwan Gastrointestinal Disease, GD 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, vol. 10, no. 5, e0124199. https://doi.org/10.1371/journal.pone.0124199
Liou, Jyh Ming ; Chang, Chi Yang ; Chen, Mei Jyh ; Chen, Chieh Chang ; Fang, Yu Jen ; Lee, Ji Yuh ; Wu, Jeng Yih ; Luo, Jiing Chyuan ; Liou, Tai Cherng ; Chang, Wen Hsiung ; Tseng, Cheng Hao ; Wu, Chun Ying ; Yang, Tsung Hua ; Chang, Chun Chao ; Wang, Hsiu Po ; Sheu, Bor Shyang ; Lin, Jaw Town ; Bair, Ming Jong ; Wu, Ming Shiang ; Tai, Chi Ming ; Lee, Ching Tai ; Wang, Wen Lun ; Lee, Yi Chia ; Wang, Yu Chi ; Taiwan Gastrointestinal Disease, Gastrointestinal Disease. / 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. In: PLoS One. 2015 ; Vol. 10, No. 5.
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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 na{\"i}ve (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.",
author = "Liou, {Jyh Ming} and Chang, {Chi Yang} and Chen, {Mei Jyh} and Chen, {Chieh Chang} and Fang, {Yu Jen} and Lee, {Ji Yuh} and Wu, {Jeng Yih} and Luo, {Jiing Chyuan} and Liou, {Tai Cherng} and Chang, {Wen Hsiung} and Tseng, {Cheng Hao} and Wu, {Chun Ying} and Yang, {Tsung Hua} and Chang, {Chun Chao} and Wang, {Hsiu Po} and Sheu, {Bor Shyang} and Lin, {Jaw Town} and Bair, {Ming Jong} and Wu, {Ming Shiang} and Tai, {Chi Ming} and Lee, {Ching Tai} and Wang, {Wen Lun} and Lee, {Yi Chia} and Wang, {Yu Chi} and {Taiwan Gastrointestinal Disease}, {Gastrointestinal Disease}",
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T1 - 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

AU - Liou, Jyh Ming

AU - Chang, Chi Yang

AU - Chen, Mei Jyh

AU - Chen, Chieh Chang

AU - Fang, Yu Jen

AU - Lee, Ji Yuh

AU - Wu, Jeng Yih

AU - Luo, Jiing Chyuan

AU - Liou, Tai Cherng

AU - Chang, Wen Hsiung

AU - Tseng, Cheng Hao

AU - Wu, Chun Ying

AU - Yang, Tsung Hua

AU - Chang, Chun Chao

AU - Wang, Hsiu Po

AU - Sheu, Bor Shyang

AU - Lin, Jaw Town

AU - Bair, Ming Jong

AU - Wu, Ming Shiang

AU - Tai, Chi Ming

AU - Lee, Ching Tai

AU - Wang, Wen Lun

AU - Lee, Yi Chia

AU - Wang, Yu Chi

AU - Taiwan Gastrointestinal Disease, Gastrointestinal Disease

PY - 2015/5/5

Y1 - 2015/5/5

N2 - 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.

AB - 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.

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