Antibiotic Resistance Rates for Helicobacter pylori in Rural Arizona: A Molecular-Based Study

• Published in: Microorganisms (Basel) 2023-09, Vol.11 (9), p.2290
• Main Authors: Monroy, Fernando P, Brown, Heidi E, Acevedo-Solis, Claudia M, Rodriguez-Galaviz, Andres, Dholakia, Rishi, Pauli, Laura, Harris, Robin B
• Format: Article
• Language: English
• Subjects: American Indian; Antibiotic resistance; Antibiotics; Bacterial diseases; Bacterial infections; Biopsy; Clarithromycin; Data analysis; Drug resistance; Endoscopy; Gastric cancer; Health services; Helicobacter pylori; Infections; Malignancy; Medical records; Metronidazole; Mutation; mutation rates; NADPH nitroreductase; Native North Americans; Nitroreductase; Patients; Populations; Review boards; rRNA; rRNA 23S; Rural populations; Sex differences; Statistical analysis
• ISSN: 2076-2607; 2076-2607
• DOI: 10.3390/microorganisms11092290

( ) is a common bacterial infection linked to gastric malignancies. While infection and gastric cancer rates are decreasing, antibiotic resistance varies greatly by community. Little is known about resistance rates among rural Indigenous populations in the United States. From 2018 to 2021, 396 endoscopy patients were recruited from a Northern Arizona clinic, where community prevalence is near 60%. Gastric biopsy samples positive for ( = 67) were sequenced for clarithromycin- and metronidazole-associated mutations, 23S ribosomal RNA (23S), and oxygen-insensitive NADPH nitroreductase ( ) regions. Medical record data were extracted for endoscopic findings and prior history. Data analysis was restricted to individuals with no history of infection. Of 49 individuals, representing 64 samples which amplified in the 23S region, a clarithromycin-associated mutation was present in 38.8%, with T2182C being the most common mutation at 90%. While the prevalence of metronidazole-resistance-associated mutations was higher at 93.9%, the mutations were more variable, with D95N being the most common followed by L62V. No statistically significant sex differences were observed for either antibiotic. Given the risk of treatment failure with antibiotic resistance, there is a need to consider resistance profile during treatment selection. The resistance rates in this population of American Indian patients undergoing endoscopy are similar to other high-risk populations. This is concerning given the high prevalence and low rates of resistance testing in clinical settings. The mutations reported are associated with antibiotic resistance, but clinical resistance must be confirmed.