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Original article
Antimicrobial susceptibility of 6 antimicrobial agents in Helicobacter pylori clinical isolates by using EUCAST breakpoints compared with previously used breakpoints
Sensibilidad de aislamientos clínicos de Helicobacter pylori a seis antimicrobianos utilizando los criterios EUCAST y comparando los resultados con criterios utilizados anteriormente
Teresa Alarcóna,b,
Corresponding author
talarcon@helicobacterspain.com

Corresponding author.
, Pedro Urruzunoc, Maria Josefa Martínezd, Diego Domingoa, Laura Llorcaa, Ana Correaa, Manuel López-Breaa
a Servicio de Microbiologia, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
b Departamento de Medicina Preventiva, Salud Pública y Microbiologia, Facultad de Medicina, Universidad Autónoma de Madrid, Spain
c Unidad de Gastroenterología Pediátrica, Hospital Universitario Doce de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
d Unidad de Gastroenterología Pediátrica, Hospital Universitario Niño Jesus, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of antibiotic MICs for <span class="elsevierStyleItalic">H&#46; pylori</span> clinical isolates&#46; MICs were determined by E-Test and adjusted to the highest two-fold dilution values&#46; MICs of amoxicillin &#40;A&#41; tetracycline &#40;B&#41;&#44; metronidazole &#40;C&#41;&#44; clarithromycin &#40;D&#41;&#44; rifampicin &#40;E&#41; and levofloxacin &#40;F&#41; are shown&#46; Filled arrows indicate the EUCAST resistance breakpoints and dashed arrows the previously used breakpoints&#46; Exe Y shows the number of <span class="elsevierStyleItalic">H&#46; pylori</span> isolates for each MIC value and Exe X shows each MIC value &#40;mg&#47;L&#41;&#46; Arrows indicates the EUCAST &#40;<elsevierMultimedia ident="201804050444524911"></elsevierMultimedia>&#41; or previous &#40;<elsevierMultimedia ident="201804050444524912"></elsevierMultimedia>&#41; resistance breakpoint&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Helicobacter pylori</span> is a Gram-negative spiral rod colonizing the gastric mucosa mainly at the antrum&#44; producing gastric inflammation&#46; Patient could remain without symptomatology for his o her whole life or develop several pathologies such as duodenal or gastric ulcer&#59; mucosa-associated lymphoid tissue &#40;MALT&#41; or gastric cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> Association with non-digestive diseases has also been described&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a> When treatment is needed&#44; several triple or quadruple therapies could be used&#46; Amoxicillin&#44; tetracycline&#44; metronidazole and clarithromycin are the antimicrobials most frequently used combined with proton pump inhibitors or bismuth salts&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> Several papers have stressed the importance of doing <span class="elsevierStyleItalic">H&#46; pylori</span> susceptibility testing before administering the treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> However&#44; different methodology could be performed for <span class="elsevierStyleItalic">in vitro</span> susceptibility testing&#46; Several Societies and Committees have defined reference methods and breakpoints for categorized organisms as susceptible or resistant to antimicrobial agents&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The National Committee for Clinical Laboratory Standard &#40;NCCLS&#41; &#40;now the Clinical and Laboratory Standards Institute&#44; CLSI&#41; proposed in 1999 and continued recommending <span class="elsevierStyleItalic">H&#46; pylori</span> breakpoints only for clarithromycin and using an agar dilution&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> The British Society for Antimicrobial Chemotherapy proposed the Epsilometer test &#40;E-test&#41;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> and recommended breakpoints for four antimicrobials&#46; Several studies conducted by the European <span class="elsevierStyleItalic">Helicobacter pylori</span> Study Group also used the E-test and proposed breakpoints for six antimicrobials&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The European Committee for Antimicrobial Susceptibility Testing &#40;EUCAST&#41; was initiated by the European Society of Clinical Microbiology and Infectious Diseases &#40;ESCMID&#41; to harmonize minimum inhibitory concentration &#40;MIC&#41; breakpoints across Europe&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a> In March&#8211;April 2011 the EUCAST group proposed breakpoints for six antimicrobials used to treat <span class="elsevierStyleItalic">H&#46; pylori&#46;</span><a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> The breakpoints are based on the epidemiological cut-off value &#40;ECOFF&#41;&#44; on clinical validation or on the study of resistance mechanisms&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The adoption of new guidelines or changes in breakpoints can have an important effect on antimicrobial-resistance surveillance&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to determine the resistance percentage in <span class="elsevierStyleItalic">H&#46; pylori</span> clinical isolates using EUCAST breakpoints comparing the results obtained with others previously used&#46; MIC value distribution in <span class="elsevierStyleItalic">H&#46; pylori</span> clinical isolates was also studied&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients and <span class="elsevierStyleItalic">H&#46; pylori</span> strains</span><p id="par0030" class="elsevierStylePara elsevierViewall">824 <span class="elsevierStyleItalic">H&#46; pylori</span> strains were isolated from antral gastric mucosal biopsy specimens obtained from symptomatic patients from January 1&#44; 2007 to December 2014&#46; 641 &#40;77&#46;8&#37;&#41; were children &#40;median age 8&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;3&#41; and 183 &#40;22&#46;2&#37;&#41; were adults &#40;median age 43&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;9&#41;&#46; 59&#46;1&#37; were females and 46&#46;8&#37; were males&#46; No data of previous eradication treatment were available&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Biopsies were cultured in selective and non-selective media obtained commercially &#40;Blood-supplemented Columbia Agar plates and Pylori agar&#44; BioMerieux&#41;&#46; <span class="elsevierStyleItalic">H&#46; pylori</span> strains were cultured under microaerobic conditions obtained in an anaerobiosis jar with a microaerobic gas-generating envelopment&#46; Strains were identified by colony and Gram stain morphology&#44; and urease&#44; oxidase and catalase positive test&#46; From November 2012&#44; any strain with a rare resistance was confirmed to be <span class="elsevierStyleItalic">H&#46; pylori</span> by MALDI-TOF&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Susceptibility methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">Susceptibility to amoxicillin &#40;AMX&#41;&#44; tetracycline &#40;TET&#41;&#44; metronidazole &#40;MET&#41;&#44; clarithromycin &#40;CLA&#41;&#44; rifampicin &#40;RIF&#41; and levofloxacin &#40;LEV&#41; was performed by the E-test&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a> The bacteria were subcultured for 48<span class="elsevierStyleHsp" style=""></span>h in Blood-supplemented Columbia agar and a bacterial suspension adjusted to 10<span class="elsevierStyleSup">7</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;mL was inoculated directly onto Mueller-Hinton agar supplemented with 5&#37; sheep blood obtained commercially &#40;bioMerieux&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">E-test was applied over the culture media within 30<span class="elsevierStyleHsp" style=""></span>min of inoculation&#46; Plates containing the E-test were incubated under microaerobic atmosphere&#46; After 72<span class="elsevierStyleHsp" style=""></span>h of incubation&#44; the Minimal Inhibitory Concentration &#40;MIC&#41; was determined by considering the point were elipse growth cut with the scale number in the E-test strip&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">To analyze the data each MIC value was adjusted to the next higher twofold dilutions &#40;as studied by broth microdilution or agar dilution&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Interpretative criteria</span><p id="par0055" class="elsevierStylePara elsevierViewall">The MICs obtained in the entire period were analyzed according to the breakpoints previously used and to EUCAST breakpoints &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5&#44;6&#44;9&#44;11&#44;12</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">95&#37; Confidence intervals &#40;95&#37;CI&#41; of prevalence rates were calculated&#46; Data were analyzed using EpiInfo 6&#46;04 &#40;CDC&#44; USA&#41; computer software&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The percentage of strains that are susceptible&#44; intermediate or resistant by using the EUCAST breakpoints and the previously used breakpoints is in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The overall percentage of resistance to the 6 antibiotics by the new EUCAST breakpoints and by the previous breakpoints was 8&#46;5&#37; and 3&#46;2&#37; for amoxicillin&#44; 0&#46;6&#37; and 0&#46;1&#37; for tetracycline&#44; 39&#46;2&#37; and 39&#46;7&#37; for metronidazole&#44; 51&#46;2&#37; and 51&#46;2&#37; for clarithromycin&#44; 32&#37; and 3&#46;1&#37; for rifampicin and 6&#46;7&#37; and 6&#46;7&#37; for levofloxacin&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The distributions of MICs for amoxicillin&#44; tetracycline&#44; metronidazole&#44; clarithromycin&#44; rifampicin and levofloxacin in <span class="elsevierStyleItalic">H&#46; pylori</span> clinical isolates are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Several triple or quadruple therapies are recommended for treatment of <span class="elsevierStyleItalic">H&#46; pylori</span> infection&#44; those being omeprazole&#44; clarithromycin and amoxicillin which are the most frequently used&#46; However&#44; infection by a clarithromycin-resistant strain is a risk factor for treatment failure<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> and other antimicrobial agents used are tetracycline&#44; metronidazole&#44; levofloxacin or rifabutin&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> Treatment for <span class="elsevierStyleItalic">H&#46; pylori</span> infection is usually started on an empirical basis&#44; and when an infecting strain is resistant to the antimicrobial agents used&#44; its successful eradication is hampered&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The amoxicillin breakpoint&#44; proposed by EUCAST&#44; was based on the epidemiological cut-off value although no evidence exists which determines whether treatment is successful for infections caused by isolates with MICs &#62;0&#46;12<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; Metronidazole cut-off was the current and widely accepted breakpoint&#44; but there is no clinical validation&#46; Clarithromycin breakpoints have been clinically validated and isolates with MIC above 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;L have a resistance mechanism &#40;23S RNA mutation&#41;&#46; Tetracycline breakpoint correlates with mutations in 16S RNA&#44; levofloxacin breakpoint with <span class="elsevierStyleItalic">gyrA</span> mutations&#44; and rifampicin breakpoint with <span class="elsevierStyleItalic">rpoB</span> mutation&#44; although there are no outcome data and there is no clinical validation&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">EUCAST guidelines for antimicrobial susceptibility testing &#40;AST&#41; are being implemented in European Laboratories&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> Adoption of new guidelines and breakpoints can have a significant effect on reports and prior to implementing new guidelines&#44; the consequences should be considered to prevent misunderstandings in interpretations&#46; In this study AST&#39;s interpretation of the EUCAST breakpoint compared with the previous one was investigated and EUCAST will lead to significantly more isolates of <span class="elsevierStyleItalic">H&#46; pylori</span> being resistant to rifampicin and amoxicillin&#46; However&#44; there are no important changes with the rest of the antimicrobial agents used for treatment of this infection&#44; A total of 8&#46;5&#37; of the strains were amoxicillin-resistant when using the EUCAST breakpoints compared with 3&#46;2&#37; for the previous breakpoints&#46; Amoxicillin is included in most treatments&#44; such as sequential&#44; concomitant and hybrid treatment&#59; resistance to this antibiotic is clinically important and requires attention&#46; On the other hand&#44; there are no clinical data to confirm if strains with MIC of 0&#46;25&#8211;0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#44; although they are amoxicillin-resistant according to EUCAST breakpoints&#44; could be eliminated with oral amoxicillin of 1<span class="elsevierStyleHsp" style=""></span>g&#47;12<span class="elsevierStyleHsp" style=""></span>h&#46; In our study most of the amoxicillin-resistant strains had low MICs&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the study done by Kim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> no amoxicillin breakpoint was used to categorized the strains&#44; although 5&#46;6&#37; of strains studied in 1994 and 18&#46;5&#37; of the strains studied in 2003 had MIC &#62;0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; Moreover&#44; two of these strains in 1994 and 3 in 2003 had an MIC of 8<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; Wu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> reported a surprisingly high prevalence of amoxicillin resistance using a breakpoint of &#62;0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#44; 71&#46;9&#37;&#44; with 115 out of 153 being higher than 0&#46;125 and 44 strains with MIC &#62;16<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">An increase of the resistance to tetracycline has been described by Kim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> reporting a resistance rate of a 5&#46;9&#37; in 1987 and 12&#46;3&#37; in 2003 with MICs &#62;4<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; Moreover&#44; Wu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> reported a surprisingly high prevalence of tetracycline resistance&#44; 58&#46;8&#37; by using a breakpoint of &#62;16&#44; with 104 out of 153 being higher than 1 and 79 strains with MIC &#62;32<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Metronidazole has been widely prescribed for infections such as parasitic or female genital infections and could contribute to the high resistance rate found everywhere&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In a European Study using the new EUCAST breakpoints&#44; <span class="elsevierStyleItalic">H&#46; pylori</span> resistance rates for adults were 17&#46;5&#37; for clarithromycin&#44; 14&#46;1&#37; for levofloxacin and 34&#46;9&#37; for metronidazole&#44; and were higher for clarithromycin and levofloxacin in Western&#47;Central and Southern Europe &#40;resistance was higher than 20&#37;&#41; than those in Northern European countries &#40;resistance lower than 10&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> Moreover&#44; an association was found between outpatient quinolone use and the proportion of levofloxacin resistance and between the use of long-acting macrolides and clarithromycin resistance&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">MIC distribution of the strains tested according to the MIC value was bimodal for metronidazole and clarithromycin&#44; whilst a continuous distribution was observed for amoxicillin&#44; tetracycline&#44; rifampicin and levofloxacin&#46; The wild type population is the subpopulation of isolates with no detectable acquired resistance mechanisms&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">19&#44;20</span></a> but the mechanism of resistance was not studied herein&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">There is a need for continuous surveillance of resistance to antimicrobial agents in <span class="elsevierStyleItalic">H&#46; pylori</span> infections as well as in other infections&#46; The knowledge of the breakpoints used in each study is mandatory when comparing data obtained from different studies&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Recently Boyanova et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> compared EUCAST with previously used breakpoint in 299 strains in Bulgaria and found similar results&#58; although there were differences for 3 of the antibiotics tested&#44; the differences in the resistant percentage was lower than 4&#37;&#46; Unfortunately&#44; rifampicin resistance is determined only with EUCAST&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">According to the results of this study&#44; no matter which breakpoint was used&#44; similar results were found for the antibiotics with high clinical relevance&#44; whilst there were differences with amoxicillin and rifampicin&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to determine the differences in percentage resistance in <span class="elsevierStyleItalic">H&#46; pylori</span> clinical isolates using EUCAST breakpoints compared with previously used breakpoints&#46; MIC value distribution in <span class="elsevierStyleItalic">H&#46; pylori</span> clinical isolates was also studied&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Susceptibility to amoxicillin&#44; tetracycline&#44; metronidazole&#44; clarithromycin&#44; rifampicin and levofloxacin was performed by E-test in 824 <span class="elsevierStyleItalic">H&#46; pylori</span> clinical isolates&#46; EUCAST and previous breakpoints defined resistance as follows&#58; MIC &#62;0&#46;12<span class="elsevierStyleHsp" style=""></span>mg&#47;L and &#8805;2<span class="elsevierStyleHsp" style=""></span>mg&#47;L for amoxicillin&#44; &#62;8<span class="elsevierStyleHsp" style=""></span>mg&#47;L and &#8805;8<span class="elsevierStyleHsp" style=""></span>mg&#47;L for metronidazole&#44; &#62;0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;L and &#8805;1<span class="elsevierStyleHsp" style=""></span>mg&#47;L for clarithromycin&#44; &#62;1<span class="elsevierStyleHsp" style=""></span>mg&#47;L and &#8805;32<span class="elsevierStyleHsp" style=""></span>mg&#47;L for rifampicin&#44; and &#62;1<span class="elsevierStyleHsp" style=""></span>mg&#47;L and &#8805;4<span class="elsevierStyleHsp" style=""></span>mg&#47;L for tetracycline and &#62;1<span class="elsevierStyleHsp" style=""></span>mg&#47;L levofloxacin&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Overall resistance rate by EUCAST and by previous breakpoints was 8&#46;5&#37; and 3&#46;2&#37; for amoxicillin&#44; 0&#46;6&#37; and 0&#46;1&#37; for tetracycline&#44; 39&#46;2&#37; and 39&#46;7&#37; for metronidazole&#44; 51&#46;2&#37; and 51&#46;2&#37; for clarithromycin&#44; 32&#37; and 3&#46;1&#37; for rifampicin&#44; and 6&#46;7&#37; and 6&#46;7&#37; for levofloxacin&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">When using the different breakpoints for antimicrobial susceptibility testing&#44; similar results were found with most antibiotics tested &#40;tetracycline&#44; metronidazole&#44; clarithromycin&#44; and levofloxacin&#41;&#44; except for amoxicillin and rifampicin&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio era determinar las diferencias en el porcentaje de resistencia de aislamientos cl&#237;nicos de <span class="elsevierStyleItalic">H&#46; pylori</span> usando los puntos de corte de EUCAST comparado con los puntos de corte usados anteriormente&#46; Tambi&#233;n se estudi&#243; la distribuci&#243;n de los valores de CMI en los aislamientos de <span class="elsevierStyleItalic">H&#46; pylori</span>&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La sensibilidad de amoxicilina&#44; tetraciclina&#44; metronidazol&#44; claritromicina&#44; rifampicina y levo-floxacina se determin&#243; mediante E-test en 824 aislamientos cl&#237;nicos de <span class="elsevierStyleItalic">H&#46; pylori</span>&#46; Los puntos de corte utilizados fueron EUCAST&#58; CMI &#62;0&#44;12<span class="elsevierStyleHsp" style=""></span>mg&#47;L para amoxicilina&#44; &#62;8<span class="elsevierStyleHsp" style=""></span>mg&#47;L para metronidazol&#44; &#62;0&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;L para claritromicina y &#62;1<span class="elsevierStyleHsp" style=""></span>mg&#47;L para rifampicina&#44; tetraciclina y levofloxacina&#46; Los puntos de corte que se hab&#237;an utilizado antes de EUCAST fueron&#58; CMI &#8805;2<span class="elsevierStyleHsp" style=""></span>mg&#47;L para amoxicilina&#44; &#8805;8<span class="elsevierStyleHsp" style=""></span>mg&#47;L para metronidazol&#44; &#8805;1<span class="elsevierStyleHsp" style=""></span>mg&#47;L para claritromicina&#44; &#8805;32<span class="elsevierStyleHsp" style=""></span>mg&#47;L para rifampicina&#44; &#8805;4<span class="elsevierStyleHsp" style=""></span>mg&#47;L para tetraciclina y &#62;1<span class="elsevierStyleHsp" style=""></span>mg&#47;L para levofloxacina&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La resistencia global con los puntos de corte EUCAST y con los puntos de corte anteriores fue&#58; 8&#44;5&#37; y 3&#44;2&#37; para amoxicilina&#44; 0&#44;6&#37; y 0&#44;1&#37; para tetraciclina&#44; 39&#44;2&#37; y 39&#44;7&#37; para metronidazol&#44; 51&#44;2&#37; y 51&#44;2&#37; para claritromicina&#44; 32&#37; y 3&#44;1&#37; para rifampicina y 6&#44;7&#37; y 6&#44;7&#37; para levofloxacina&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A pesar de la utilizaci&#243;n de diferentes puntos de corte&#44; se obtuvieron resultados de resistencia similares para la mayor&#237;a de los antibi&#243;ticos probados &#40;tetraciclina&#44; metronidazol&#44; claritrnn&#241;omicina&#44; y levofloxacino&#41;&#44; con la &#250;nica excepci&#243;n de amoxicilina y rifampicina&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of antibiotic MICs for <span class="elsevierStyleItalic">H&#46; pylori</span> clinical isolates&#46; MICs were determined by E-Test and adjusted to the highest two-fold dilution values&#46; MICs of amoxicillin &#40;A&#41; tetracycline &#40;B&#41;&#44; metronidazole &#40;C&#41;&#44; clarithromycin &#40;D&#41;&#44; rifampicin &#40;E&#41; and levofloxacin &#40;F&#41; are shown&#46; Filled arrows indicate the EUCAST resistance breakpoints and dashed arrows the previously used breakpoints&#46; Exe Y shows the number of <span class="elsevierStyleItalic">H&#46; pylori</span> isolates for each MIC value and Exe X shows each MIC value &#40;mg&#47;L&#41;&#46; Arrows indicates the EUCAST &#40;<elsevierMultimedia ident="201804050444524911"></elsevierMultimedia>&#41; or previous &#40;<elsevierMultimedia ident="201804050444524912"></elsevierMultimedia>&#41; resistance breakpoint&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1&#37; &#40;0&#46;02&#8211;0&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;6&#37; &#40;0&#46;2&#8211;1&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;2&#37; &#40;44&#46;8&#8211;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9&#37; &#40;0&#46;4&#8211;1&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">From Fujimura et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a></p>"
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                      "titulo" => "<span class="elsevierStyleItalic">Helicobacter pylori</span>&#58; friend or foe&#63;"
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                          "autores" => array:5 [
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                            4 => "J&#46; Yahav"
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                      "titulo" => "Clinical effects of <span class="elsevierStyleItalic">Helicobacter pylori</span> outside the stomach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Franceschi"
                            1 => "G&#46; Zuccal&#224;"
                            2 => "D&#46; Roccarina"
                            3 => "A&#46; Gasbarrini"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1038/nrgastro.2013.243"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Gastroenterol Hepatol"
                        "fecha" => "2014"
                        "volumen" => "11"
                        "paginaInicial" => "234"
                        "paginaFinal" => "242"
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                      "titulo" => "Natural products and food components with anti-<span class="elsevierStyleItalic">Helicobacter pylori</span> activities"
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                            2 => "N&#46; Morimoto"
                            3 => "Y&#46; Nishida"
                            4 => "Y&#46; Matsumura"
                            5 => "T&#46; Sugiura"
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Article information
ISSN: 0213005X
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos