RSS Feeds
Long-Term Persistence of Resistant Enterococcus Species after Antibiotics To Eradicate Helicobacter pylori
- Maria Sjölund, MSc;
- Karin Wreiber, MSc;
- Dan I. Andersson, PhD;
- Martin J. Blaser, MD; and
- Lars Engstrand, MD
- From University Hospital Uppsala, Uppsala, and The Swedish Institute for Infectious Disease Control, Solna, Sweden; and New York University School of Medicine, New York, New York.
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.
Article and Author Information
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Acknowledgments: The authors thank Lena Zimmergren for coordinating the collection of samples and Lena Eriksson and Kristina Schönmeyr for excellent technical assistance.
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Grant Support: By the AFA Health Research Foundation, Stockholm, Sweden, and by the National Institutes of Health (RO1GM63270).
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Lars Engstrand, MD, Department of Bacteriology, Swedish Institute for Infectious Disease Control, SE-171 82 Solna, Sweden; e-mail, lars.engstrand{at}smi.ki.se.
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Current Author Addresses: Ms. Sjölund: Department of Medical Sciences, Clinical Bacteriology, University Hospital Uppsala, Box 552, SE-751 22 Uppsala, Sweden.
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Ms. Wreiber and Drs. Andersson and Engstrand: Department of Bacteriology, Swedish Institute for Infectious Disease Control, SE-171 82 Solna, Sweden.
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Dr. Blaser: Departments of Medicine and Microbiology, New York University School of Medicine, New York, NY 10016.
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Author Contributions: Conception and design: M. Sjölund, L. Engstrand.
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Analysis and interpretation of the data: M. Sjölund, D.I. Andersson, M.J. Blaser, L. Engstrand.
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Drafting of the article: M. Sjölund, D.I. Andersson, M.J. Blaser, L. Engstrand.
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Critical revision of the article for important intellectual content: M. Sjölund, D.I. Andersson, M.J. Blaser, L. Engstrand.
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Final approval of the article: M. Sjölund, K. Wreiber, D.I. Andersson, M.J. Blaser, L. Engstrand.
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Provision of study materials or patients: K. Wreiber.
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Obtaining of funding: L. Engstrand.
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Administrative, technical, or logistic support: K. Wreiber, L. Engstrand.
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Collection and assembly of data: K. Wreiber, L. Engstrand.
- Copyright ©2004 by the American College of Physicians
