Publications

@article{Garvey2023-ao,

title = {High incidence of antibiotic resistance amongst isolates of 

 Helicobacter pylori collected in Nottingham, UK, between 2001 

 and 2018},

author = {Elizabeth Garvey and Joanne Rhead and Suffi Suffian and Daniel Whiley and Farah Mahmood and Naveen Bakshi and Darren Letley and Jonathan White and John Atherton and Jody Anne Winter and Karen Robinson},

year  = {2023},

date = {2023-11-01},

journal = {J. Med. Microbiol.},

volume = {72},

number = {11},

publisher = {Microbiology Society},

abstract = {Introduction. Helicobacter pylori is the leading cause of peptic 

 ulcers and gastric cancer. The most common treatment regimens 

 use combinations of two or three antibiotics and a proton pump 

 inhibitor (PPI) to suppress stomach acid. The World Health 

 Organization designated clarithromycin-resistant H. pylori as a 

 high priority pathogen for drug development, due to increasing 

 antibiotic resistance globally.Hypothesis/Gap Statement. There 

 is no routine surveillance of H. pylori primary antimicrobial 

 sensitivities in the UK, and published data are lacking.Aim. 

 This study aimed to characterize antimicrobial sensitivities of 

 isolates collected in Nottingham, UK, between 2001 and 

 2018.Methodology. Gastric biopsy samples were collected, with 

 informed written consent and ethics approval, from 162 patients 

 attending the Queen's Medical Centre in Nottingham for an upper 

 GI tract endoscopy. Antibiotic sensitivity was assessed using 

 E-Tests and a more cost-effective disc diffusion test.Results. 

 The clarithromycin, amoxicillin and levofloxacin disc diffusion 

 tests provided identical results to E-Tests on a subset of 30 

 isolates. Disparities were observed in the metronidazole test 

 results, however. In total, 241 isolates from 162 patients were 

 tested using at least one method. Of all isolates, 28 % were 

 resistant to clarithromycin, 62 % to metronidazole and 3 % to 

 amoxicillin, which are used in first-line therapies. For those 

 antibiotics used in second- and third-line therapies, 4 % were 

 resistant to levofloxacin and none of the isolates were 

 resistant to tetracycline. Resistance to more than one 

 antibiotic was found in 27 % of isolates. The frequency of 

 patients with a clarithromycin-resistant strain increased 

 dramatically over time: from 16 % between 2001 and 2005 to 40 % between 2011 and 2018 (P=0.011). For the same time periods, 

 there was also an increase in those with a metronidazole-resistant strain (from 58 to 78 %; P=0.05). The 

 frequencies of clarithromycin and metronidazole resistance were 

 higher in isolates from patients who had previously received 

 eradication therapy, compared to those who had not (40 % versus 

 77 %, and 80 % versus 92 %, respectively). Of 79 pairs of 

 isolates from the antrum and corpus regions of the same 

 patient's stomach, only six had differences in their 

 antimicrobial susceptibility profiles.Conclusion. Although there 

 was high and increasing resistance to clarithromycin and 

 metronidazole, there was no resistance to tetracycline and the 

 frequencies of amoxicillin and levofloxacin resistance were very 

 low.},

keywords = {amoxicillin, antimicrobial resistance, clarithromycin, Helicobacter pylori, levofloxacin, metronidazole, susceptibility   testing},

pubstate = {published},

tppubtype = {article}

}

@article{Robinson2021-la,

title = {The spectrum of Helicobacter-mediated diseases},

author = {Karen Robinson and John C Atherton},

year  = {2021},

date = {2021-01-01},

journal = {Annu. Rev. Pathol.},

volume = {16},

number = {1},

pages = {123\textendash144},

publisher = {Annual Reviews},

abstract = {Helicobacter pylori is the leading cause of peptic ulcer 

 disease. The infection has been implicated in more than 75% of 

 duodenal ulcer cases and 17% of gastric ulcer cases. H. pylori 

 has been classified as a human carcinogen, since it is the main 

 cause of distal gastric adenocarcinoma and B cell 

 mucosa-associated lymphoid tissue lymphoma. Evidence also links 

 H. pylori with extragastric conditions including iron deficiency 

 anemia, idiopathic thrombocytopenic purpura, and vitamin B12 

 deficiency. Studies indicate that H. pylori may be protective 

 against other conditions of the gastrointestinal tract (e.g., 

 reflux esophagitis and related pathologies) and elsewhere in the 

 body (e.g., asthma). The infection is asymptomatic in the vast 

 majority of cases; more serious outcomes occur in only 10-15% 

 of infected individuals. Despite extensive research over the 

 past 3 decades, there is no effective vaccine, and the 

 circumstances leading to disease development remain unclear. In 

 addition, there is now a growing prevalence of antimicrobial 

 resistance in H. pylori. This review discusses these important 

 issues.},

keywords = {antimicrobial resistance, duodenal ulcer, gastric adenocarcinoma, gastric ulcer, gastritis, Helicobacter pylori, MALT lymphoma, reflux esophagitis},

pubstate = {published},

tppubtype = {article}

}