dc.description.abstract |
Background: Helicobacter pylori (H. pylori) infection
is associated with upper gastrointestinal diseases
including peptic ulcer disease, gastritis, gastric
adenocarcinoma and mucosal associated lymphoid
tissue lymphoma. H. pylori is a fastidious organism and
thus difficult to culture especially after prolonged time
between sample extraction and start of the culture.
Triple therapy eradication regimens are available with
little data on current antibiotic sensitivity patterns.
Objective: To determine the H. pylori culture rate
and resistance patterns following 20 to 24 hour
transportation in normal saline at Moi Teaching and
Referral Hospital (MTRH).
Design: Cross-sectional descriptive study.
Methods: Participants aged 18 years and above
referred for endoscopy due to dyspepsia were
consecutively enrolled until the desired sample size
was achieved. Participants underwent endoscopy
during which biopsies were taken, two each from the
gastric antrum and corpus. Rapid Urease Test (RUT)
for H. pylori was done on one sample each from
the antrum and corpus. For the samples that tested
positive, their pair samples were put in normal saline
and packed in ice in a cooler box and sent for H. pylori
culture within 20 to 24 hours on brain heart infusion
agar and subsequent antibiotic susceptibility testing.
Results: Between April 2014 and February 2015, 634
patients were screened of which 156 were enrolled
to the study and subsequently underwent endoscopy,
gastric biopsy and RUT. The enrolled participants had
a median age of 41 (IQR: 28-58) years; and comprised
of 64 (41%) males. The main indication for endoscopy
was epigastric pains, seen in 151 (97%) of patients.
Forty two (27%) of participants had previously
received treatment for dyspepsia with either a proton
pump inhibitor, histamine receptor type 2 blocker
or anti H. pylori antibiotics. Eighty three (53%) had
a positive RUT. Culture was done on 69 samples that
reached the laboratory within 24 hours. H. pylori was
isolated in 9 (13%) samples. All the 9 strains of H.
pylori isolated were resistant to metronidazole. There
was no resistance to clarithromycin.
Conclusion and recommendations: The culture rate of
H. pylori following 20 to 24 hour delay was low. All the H.
pylori strains isolated were resistantto metronidazole.
Culture of H. pylori after 20-24 hour transportation
in normal saline is not useful. A comparative study
to determine the optimal transportation time and
transport media is recommended. Clarithromycin
based therapies without metronidazole is appropriate
for H. pylori eradication regimens |
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