Antimicrobial resistance among helicobacter bacteria isolates from patients attending the gastroenterology unit at Nsambya hospital Kampala, Uganda

Abstract

Background: It is confirmed that 95% of duodenal and 80% of gastric ulcers are due to Helicobacter infections. Helicobacter diagnosis is mainly by urea breath test, blood antibody test, stool antigen test, gastric biopsy and culture. In Western Europe the prevalence of Helicobacter infection is estimated to be 34.3%, North America 37.1% and Africa 70.1% with Nigeria leading with 87.7% and Uganda 68%. Despite wide use of these combination therapies in Uganda which includes a combination of a proton inhibitor, amoxicillin, metronidazole or omeprazole with the second line drugs being fluoroquinolones and tetracycline, antimicrobial resistance to isolates of Helicobacter is becoming a major clinical problem undermining the efficacy of eradication regimens which had shown good effects in the past. In this study we determined the proportion of Helicobacter antigen positive and negative specimens giving a positive Helicobacter culture result, the prevalence of resistance to amoxicillin, clarithromycin, levofloxacin, tetracycline, metronidazole and rifampicin among the Helicobacter isolates and the factors associated with drug resistant Helicobacter in Uganda. Methods and materials: This was a cross-sectional study that recruited 146 participants with peptic ulcer disease from Nsambya hospital, Uganda. Stool and gastric biopsy samples were collected and tested for Helicobacter antigen using a rapid diagnostic test. Helicobacter isolates were cultured using selective agar media and antimicrobial susceptibility testing was performed using Ezy MICTM strips (HiMedia, India). Minimum inhibitory concentration breakpoints were interpreted according to EUCAST guidelines. Data was analyzed using IBM SPSS. Results and conclusion: A total of 146 participants clinically diagnosed with peptic ulcer disease were recruited. Gastric biopsy samples collected from endoscopy by the surgeon were 143/146 (97.9%).81/146 (55.5%) females recruited into the study. The median age was 42 and SD 17.6 years. A total of 53/143 (37.1%) gastric biopsy samples tested positive for Helicobacter antigen, 44/143 (31.0%) were culture positive, 22/143 (15.4%) gastric biopsy samples were both Helicobacter antigen and culture positive. Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline and rifampicin was 45/46 (97.8%), 44/46 95.7%, 44/46 95.7%, 35/46 76.1%, 32/46 69.6% and 24/46 52.2% respectively History of treatment (p-value = 0.03). Duration of illness (p-value = 0.034), and bloating (p-value = 0.045). Antimicrobial resistance among Helicobacter isolates in Kampala, Uganda is very high and amoxicillin is the most resistant drug with over 90% resistance and rifampicin is the most susceptible drug for treating Helicobacter infection.