Miguel Castrejon

Biology 1625-026-F16
Nicole Pearson
November 14, 2016.
Antimicrobial Resistance and Risk Factors among Helicobacter Pylori-Infected Persons.
Helicobacter Pylori is a type of bacteria which enters your body and lives in your
digestive tract. This bacteria can cause sores, called ulcers inside your small intestine. This also
leads to peptic ulcer disease and an etiologic agent in the development of gastric cancer. With the
help of antimicrobial agents, such as clarithromycin and metronidazole, H. pylori is curable but
its hard due to antimicrobial resistance which leads into treatment failure.
Approximately 20% of persons infected with H. pylori develop related gastroduodenal
disorders.
HARP, the Helicobacter Pylori Antimicrobial Resistance Monitoring Project is a
prospective, longitudinal network which monitors the ongoing national and regional trends of
antimicrobial resistance in H. pylori in the United States.
HARP consisted of 11 hospitals in the United States which put together a list and data of
those who seeked help regarding H. pylori. Isolates were placed in trypticase soy broth, TSB,
supplemented with glycerol and stored at -70 degree celsius. The isolates were sent to the Atlanta
Veterans Affairs Hospital and packed in 6 pounds of dry ice maintained at -70 and -80 degree
celsius.
Inside the laboratory, isolates were cultured on heart infusion agar, a highly nutritious
general-purpose growth medium, with 5% rabbit blood at 37 degree celsius for 72 hours.
Antimicrobial susceptibility was performed by the agar dilution method in accordance with
National Committee for Clinical Laboratory Standards protocols, except that defibrinated rabbit
blood was used instead of aged sheep blood.
MS Access 2000 database was used to keep and analyze data by using SAS. Differences
between patients that were infected with H. pylori and those who were not, were assessed by
using the Fisher exact test, Mantel-Haenszel chi-square, or Student t test, as appropriate. To
determine antimicrobial resistance rate trends were analyzed by a one-way analysis of variance
(ANOVA). When he risk factor was <= 2, they excluded the risk factor from further analysis
because of the possibility of arriving at a spurious association caused by small cell-size
variations. Two models were assessed, the first one assessed significant univariate risk factors for
antimicrobial resistance and the second one was created conditioning on geographic location of
HARP site.
Out of the 317 participants, 205 were male, 116 were white, 172 were black, 14 were
asian, 3 were native americans, and 12 were of other ethnic background. The median age was 57
years. Among males, 97 were white, 90 were black, 9 were Asian, 1 was Native American, and 8
were of other ethnic backgrounds. Among females, 19 were white, 82 were black, 5 were Asian,
2 were Native American, and 4 were of other ethnic backgrounds.

Among 347 H. pylori isolates submitted to HARP, 118 were resistant to >= 1
antimicrobial agent, 101 were resistant to one agent only, and 17 were resistant to more than one
antimicrobial agent. 3 isolates were resistant to anoxcillin, 45 to clarithromycin, 87 to
metronidazole, and no isolate was found to be resistant to tetracycline. Most isolates were
submitted by centers in the Northeast region, followed by the south, midwest, and the west.
Isolates from the northeast region had the highest frequency of single- and dual-agent resistance.
The isolates from the midwest region had the second-highest single agent resistance rate, while
the southern region had the second-highest dual agent resistance rate. After all the data was put
together, its clear to say that more H. pylori bacteria has more resistance to Metronidazole than
any other agents.
The resistance against antimicrobial agents from H. pylori presents a serious problem to
our public health services because of the prevalence of infection and incidence of severe
sequelae. H. pylori resistance is amply documented in a variety of different populations, covering
most of the globe.
There are many published studies out there but most have been based on cross-sectional
designs, not in prospective population-based surveillance of resistance like this study has done.
HARP is the only multicenter network providing ongoing prospective antimicrobial resistance
and associated risk factor data for H. pylori in North America.
This study demonstrates how black race and the infection with an antimicrobial-resistant
H. pylori associate. This association between H. pylori infection and blacks in the united states
has been amply documented, but the association between incidence of h. Pylori resistance and
black race is new. This means that it has several limitations. Even though the HARP sites were
drawn from various regions in the United States, they might not be representing a convenient
sample of academic medical centers in the United States.
Most of the participating hospital sites serve adult populations, and thus the results
largely reflect resistance incidence towards adult patients.
In short, the summary talks about which ethnicity is more susceptible to getting infected
with H. pylori resistant to antimicrobial agents, like it was said before it is a really big challenge
in public health because it will most of the time lead into treatment failure. This antimicrobial
event is also believed to be found in many other bacterias making this a much bigger problem
than first projected.