Long-Term Persistence of Resistant Enterococcus Species after Antibiotics to Eradicate Helicobacter pylori

Maria Sjölund, Karin Wreiber, Dan I. Andersson, Martin Blaser, Lars Engstrand

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Background: Antibiotic treatment selects for resistance not only in the pathogen to which it is directed but also in the indigenous microflora. Objective: To determine whether a widely used regimen (clarithromycin, metronidazole, and omeprazole) for Helicobacter pylori eradication affects resistance development in enterococci. Design: Cohort study. Setting: Endoscopy units at 3 community hospitals in Sweden. Patients: 5 consecutive dyspeptic patients who were colonized with H. pylori, had endoscopy-confirmed duodenal ulcer, and received antibiotic treatment, and 5 consecutive controls with dyspepsia but no ulcer who did not receive treatment. Measurements: Fecal samples were obtained from patients and controls before, immediately after, 1 year after, and 3 years after treatment. From each patient and sample, enterococci were isolated and analyzed for DNA fingerprint, clarithromycin susceptibility, and presence of the erm(B) gene. Results: In treated patients, all enterococci isolated immediately after treatment showed high-level clarithromycin resistance due to erm(B). In 3 patients, resistant enterococci persisted for 1 to 3 years after treatment. No resistance developed among controls. Conclusion: A common H. pylori treatment selects for highly resistant enterococci that can persist for at least 3 years without further selection.

Original languageEnglish (US)
Pages (from-to)483-487+I42
JournalAnnals of internal medicine
Volume139
Issue number6
StatePublished - Sep 16 2003
Externally publishedYes

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Enterococcus
Helicobacter pylori
Anti-Bacterial Agents
Clarithromycin
Therapeutics
Endoscopy
Omeprazole
DNA Fingerprinting
Dyspepsia
Community Hospital
Metronidazole
Duodenal Ulcer
Sweden
Ulcer
Cohort Studies
Genes

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Sjölund, Maria ; Wreiber, Karin ; Andersson, Dan I. ; Blaser, Martin ; Engstrand, Lars. / Long-Term Persistence of Resistant Enterococcus Species after Antibiotics to Eradicate Helicobacter pylori. In: Annals of internal medicine. 2003 ; Vol. 139, No. 6. pp. 483-487+I42.
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Sjölund, M, Wreiber, K, Andersson, DI, Blaser, M & Engstrand, L 2003, 'Long-Term Persistence of Resistant Enterococcus Species after Antibiotics to Eradicate Helicobacter pylori', Annals of internal medicine, vol. 139, no. 6, pp. 483-487+I42.

Long-Term Persistence of Resistant Enterococcus Species after Antibiotics to Eradicate Helicobacter pylori. / Sjölund, Maria; Wreiber, Karin; Andersson, Dan I.; Blaser, Martin; Engstrand, Lars.

In: Annals of internal medicine, Vol. 139, No. 6, 16.09.2003, p. 483-487+I42.

Research output: Contribution to journalArticle

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N2 - Background: Antibiotic treatment selects for resistance not only in the pathogen to which it is directed but also in the indigenous microflora. Objective: To determine whether a widely used regimen (clarithromycin, metronidazole, and omeprazole) for Helicobacter pylori eradication affects resistance development in enterococci. Design: Cohort study. Setting: Endoscopy units at 3 community hospitals in Sweden. Patients: 5 consecutive dyspeptic patients who were colonized with H. pylori, had endoscopy-confirmed duodenal ulcer, and received antibiotic treatment, and 5 consecutive controls with dyspepsia but no ulcer who did not receive treatment. Measurements: Fecal samples were obtained from patients and controls before, immediately after, 1 year after, and 3 years after treatment. From each patient and sample, enterococci were isolated and analyzed for DNA fingerprint, clarithromycin susceptibility, and presence of the erm(B) gene. Results: In treated patients, all enterococci isolated immediately after treatment showed high-level clarithromycin resistance due to erm(B). In 3 patients, resistant enterococci persisted for 1 to 3 years after treatment. No resistance developed among controls. Conclusion: A common H. pylori treatment selects for highly resistant enterococci that can persist for at least 3 years without further selection.

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