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Journal of Clinical Microbiology, December 2007, p. 4006-4010, Vol. 45, No. 12
0095-1137/07/$08.00+0     doi:10.1128/JCM.00740-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Changing Antimicrobial Susceptibility Epidemiology of Helicobacter pylori Strains in Japan between 2002 and 2005{triangledown}

Intetsu Kobayashi,1* Kazunari Murakami,2 Mototsugu Kato,3 Seiichi Kato,4 Takeshi Azuma,5 Shin'ichi Takahashi,6 Naomi Uemura,7 Tsutomu Katsuyama,8 Yoshihiro Fukuda,9 Ken Haruma,10 Masaru Nasu,11 and Toshio Fujioka12

Chemotherapy Division, Mitsubishi Chemical Medience Corporation, 3-30-1 Shimura Itabashi-ku, Tokyo 174-8555, Japan,1 Department of Gastroenterology, Oita University Faculty of Medicine, 1-1 Idaiga-oka Hasama-machi, Oita 879-5593, Japan,2 Division of Endoscopy, Hokkaido University Hospital, Kita-14-jyo Nishi-7-chome, Kita-ku Sapporo-shi, Hokkaido 060-0814, Japan,3 Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi Aoba-ku Sendai 980-8574, Japan,4 Department of Gastroenterology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho Chuo-ku Kobe-shi, Hyogo 650-0017, Japan,5 Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa Mitaka-shi, Tokyo 181-8611, Japan,6 Department of Gastroenterology, International Medical Center of Japan, 1-21-1 Toyama Shinjuku-ku, Tokyo 162-8655, Japan,7 Laboratory Medicine, Shinshu University Graduate School of Medicine, 3-1-1 Asashi Matsumoto-shi, Nagano 390-8621, Japan,8 Clinical Nutrition and Health Science, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya-shi, Hyogo 663-8501, Japan,9 Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, 577 Matsushima Kurashiki-shi, Okayama 701-0192, Japan,10 General Clinical Research Center, Oita Nakamura Hospital, 3-2-43 Ote-machi, Oita 870-0022, Japan,11 Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1 Idaiga-oka Hasama-machi, Oita 879-5593, Japan,12

Received 5 April 2007/ Returned for modification 3 July 2007/ Accepted 4 October 2007

Surveillance of Helicobacter pylori antimicrobial susceptibility reflecting the general population in Japan is limited. The antimicrobial susceptibilities of 3,707 H. pylori strains isolated from gastric mucosa samples of previously untreated patients diagnosed with gastroduodenal diseases at 36 medical facilities located throughout Japan between October 2002 and September 2005 were evaluated. Using an agar dilution method for antimicrobial susceptibility testing of H. pylori, the MIC distributions and trends during the study period for clarithromycin, amoxicillin, and metronidazole were studied. While the MIC50 and MIC90 for clarithromycin did not change during the 3-year period, the MIC80 showed a 128-fold increase. Furthermore, the rate of resistance increased yearly from 18.9% (2002 to 2003) to 21.1% (2003 to 2004) and 27.7% (2004 to 2005). With a resistance rate of 19.2% among males compared to 27.0% among females, a significant gender difference was observed (P < 0.0001). Our study shows that in Japan, there is an evolving trend towards increased resistance to clarithromycin with geographical and gender differences as well as between clinical disease conditions. No significant changes in resistance were observed for amoxicillin and metronidazole during the period. While the benefit of H. pylori antimicrobial susceptibility testing has been debated in Japan, current empirical regimens are not based on susceptibility data representative of the general population. The development of an effective H. pylori eradication regimen in Japan will require continued resistance surveillance as well as a better understanding of the epidemiology of resistance.

* Corresponding author. Mailing address: Chemotherapy Division, Mitsubishi Chemical Medience Corporation, 3-30-1 Shimura Itabashi-ku, Tokyo 174-8555, Japan. Phone: 81-3-5994-2334. Fax: 81-3-5994-2939. E-mail: mbc-ka{at}sa2.so-net.ne.jp

{triangledown} Published ahead of print on 17 October 2007.

Journal of Clinical Microbiology, December 2007, p. 4006-4010, Vol. 45, No. 12
0095-1137/07/$08.00+0     doi:10.1128/JCM.00740-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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