Muhammad Miftahussurur and Ari Fahrial Syam, Ari Fahrial Syam and Iswan Abbas Nusi, Iswan Abbas Nusi and Dadang Makmun, Dadang Makmun and Langgeng Agung Waskito, Langgeng Agung Waskito and Lukman Hakim Zein, Lukman Hakim Zein and Fardah Akil, Fardah Akil and Willy Brodus Uwan, Willy Brodus Uwan and David Simanjuntak, David Simanjuntak and I Dewa Nyoman Wibawa, I Dewa Nyoman Wibawa and Jimmy Bradley Waleleng, Jimmy Bradley Waleleng and Alexander Michael Joseph Saudale, Alexander Michael Joseph Saudale and Fauzi Yusuf, Fauzi Yusuf and Syifa Mustika, Syifa Mustika and Pangestu Adi, Pangestu Adi and Ummi Maimunah, Ummi Maimunah and Hasan Maulahela, Hasan Maulahela and Yudith Annisa Ayu Rezkitha, Yudith Annisa Ayu Rezkitha and Phawinee Subsomwong, Phawinee Subsomwong and Nasronudin, Nasronudin and Dadik Rahardjo, Dadik Rahardjo and Rumiko Suzuki, Rumiko Suzuki and Junko Akada, Junko Akada and Yoshio Yamaoka, Yoshio Yamaoka (2016) Surveillance of Helicobacter pylori antibiotic susceptibility in Indonesia: Different resistance types among regions and with novel genetic mutations. PLoS ONE, 11 (12). ISSN 19326203

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Abstract

Information regarding Helicobacter pylori antibiotic resistance in Indonesia was previously inadequate. We assessed antibiotic susceptibility for H. pylori in Indonesia, and determined the association between virulence genes or genetic mutations and antibiotic resistance. We recruited 849 dyspeptic patients who underwent endoscopy in 11 cities in Indonesia. E-test was used to determine the minimum inhibitory concentration of five antibiotics. PCR-based sequencing assessed mutations in 23S rRNA, rdxA, gyrA, gyrB, and virulence genes. Next generation sequencing was used to obtain full-length sequences of 23S rRNA, infB, and rpl22. We cultured 77 strains and identified 9.1 with clarithromycin resistance. Low prevalence was also found for amoxicillin and tetracycline resistance (5.2 and 2.6, respectively). In contrast, high resistance rates to metronidazole (46.7) and levofloxacin (31.2) were demonstrated. Strains isolated from Sumatera Island had significantly higher metronidazole resistance than those from other locations. Metronidazole resistant strains had highly distributed rdxA amino acid substitutions and the 23S rRNA A2143G mutation was associated with clarithromycin resistance (42.9). However, one strain with the highest MIC value had a novel mutation in rpl22 without an A2143G mutation. Mutation at Asn-87 and/or Asp- 91 of gyrA was associated with levofloxacin-resistance and was related to gyrB mutations. In conclusions, although this is a pilot study for a larger survey, our current data show that Indonesian strains had the high prevalence of metronidazole and levofloxacin resistance with low prevalence of clarithromycin, amoxicillin, and tetracycline resistance. Nevertheless, clarithromycin- or metronidazole-based triple therapy should be administered with caution in some regions of Indonesia. © 2016 Miftahussurur et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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