Kyler Cipriano

BIOL 1615
Antimicrobial Resistance Incidence and Risk Factors among
Helicobater pylori-Infected Persons, United States

Helicobacter pylori is a primary cause of peptic ulcer disease and a developmental agent
in gastric cancer. The infection effects approximately 50% of the worldwide population and up
to 80%-90% in developing countries. In the United States, where this particular study took place,
approximately 35% - 40% of the population is affected. In the past Helicobacter pylori has been
cured through treatment regimens of antimicrobial agents. Some of the antimicrobial agents used
are: metronidazole, amoxicillin, tetracycline, or clarithromycin in combination with a proton
pump inhibitor or bismuth. Antimicrobial resistance is a leading cause of failure in these types of
treatments. It was stated in the study that, the emergence of antimicrobial resistance in
Helicobater pylori represents a serious public health challenge because of the prevalence of
infection and incidence of severe sequelae. A 12-fold increase in resistance to antimicrobial
agents such as clarithromycin has been documented in cases in which antimicrobial therapy
regimens do not eliminate Helicobater pylori. The purpose of this study is to document the
trends of emerging resistance in order to assist physicians in formulating therapy
recommendations. The Helicobacter pylori Antimicrobial Resistance Monitoring Program
(HARP) is a multicenter network system that tracks the incidence of the Helicobacter pylori
resistance. HARP is the organization that performed this study.
It was hypothesized that greater resistance would be found among those of low
socioeconomic status, overcrowding, poor sanitation or hygiene, and those living in a developing
country. This group is often reflected in the minority population or blacks in the United States.

The following methods were used to test the patterns of resistant strains of Helicobater
pylori. 11 hospitals across the United States were involved in this study. The first five
individuals seeking treatment for confirmed cases of the Helicobater pylori infection were
enrolled. Culture of biopsied Helicobater pylori were isolated placed in trypticas soy broth
supplemented with glycerol, stored at -70 deg C, and sent to the Center for Disease Control and
Prevention. Differences between infected patients with resistant and those with susceptible
strains were assessed to determine trends among demographics and other factors that may
influence antimicrobial resistance.
Of the isolates of Helicobater pylori submitted to HARP the following percentages of
resistance were found: 34% were resistant to >1 antimicrobial agent, 29% were resistant to one
agent only, 5% were resistant to more than one. 1% were resistant to amoxicillin, 13% were
resistant to clarithromycin, 25% were resistant to metronidazole and 0% were found resistant to
tetracycline. Multi-agent resistance was also observed for clarithromycin with amoxicillin (.3%)
and clarithromycin with metronidazole (5%).
The data collected showed Helicobater pylori among the whites, blacks, Asians, Native
Americans, and other ethnicities. Of the participants enrolled 37% were white, 54% were black,
4% were Asian, 1% were Native American and 4% were of other ethnicities. When analyzed the
most significant risk associated with infection with an antimicrobial resistant strain of
Helicobater pylori was being black. One limitation on the study was that the populations in
which the health centers were located did not always reflect the overall population ratio.
The results supported the hypothesis that the antimicrobial resistant strains of Helicobater
pylori would be found among the lower socioeconomic status (blacks). Another significant risk
factor found was having received previous treatment for the infection within 5 years.

Work Cited
Duck, W. M., Sobel, J., Pruckler, J. M., Song, Q., Swerdlow, D., Friedman, C.
Gold, B. D. (2004). Antimicrobial Resistance Incidence and Risk Factors among
Helicobacter pylori Infected Persons, United States. Emerg. Infect. Dis, 10(6), 10881094. doi:10.3201/eid1006.030744