Annals of Clinical Microbiology, The official Journal of the Korean Society of Clinical Microbiology


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Multicenter Study for the Frequency of 23S rRNA Point Mutations Associated with Clarithromycin Resistance in Helicobacter pylori in Korea

Original article

Annals of Clinical Microbiology (Ann Clin Microbiol) 2008 December Volume 11, Issue 2, pages 84-89.

Multicenter Study for the Frequency of 23S rRNA Point Mutations Associated with Clarithromycin Resistance in Helicobacter pylori in Korea

Hae Kyung Lee1, Hiun Suk Chae2, Jung Oak Kang3, Mi-Kyung Lee4, Heungsup Sung5, Mi-Na Kim5, Jongwook Lee6, Miae Lee7, Ki-Nam Shim8
Departments of 1Laboratory Medicine, 2Internal Medicine, The Catholic University of Korea College of Medicine, 3Department of Laboratory Medicine, Hanyang University College of Medicine, 4Department of Laboratory Medicine, Chung-Ang University College of Medicine, 5Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, 6Hanaro Medical Foundation, Departments of 7Laboratory Medicine, 8Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea


Background: Clarithromycin resistance in Helicobacter pylori is a major cause of eradication therapy failure. The objective of this study was to determine the frequency and type of mutations in the 23S rRNA gene in Korea, which are associated with clarithromycin resistance. 

Methods: From January 2008 to March 2008, 353 gastric biopsy specimens were collected from five university hospitals in Seoul and Kyunggido. H. pylori infection was defined as showing a positive result in at least one of the following three tests: a microaerophilic culture, a CLO test, and a Giemsa/silver stain. The frequencies of A2143G, A2142G, and the wild type of 23S rRNA and the presence of H. pylori were determined by Seeplex ClaR-H. pylori PCR (Seegene Inc., Seoul, Korea). Twenty-nine culture isolates were tested for susceptibility to clarithromycin by E-test (AB Biodisk, Solna, Sweden) or the CLSI (Clinical and Laboratory Standards Institute) disk diffusion test. 

Results: From 176 H. pylori PCR-positive specimens, 23S rRNA gene mutations were detected in 38 isolates (21.6%), including 27 isolates of A2143G and 11 isolates of A2142G. Total mutation rates varied from 15.8% to 31.3% with the frequency of A2143G mutation alone varying from 8.5% to 25.0% among the five hospitals studied. There were 10 clarithromycin-resistant isolates found by susceptibility test and they were all positive for A2143G mutation. But, 3 of the 19 susceptible isolates were also positive for either A2143G or A2142G mutation. 

Conclusion: In Korea, the overall frequency of clarithromycin-resistant H. pylori was 21.6%; however, the type and frequency of the 23S rRNA mutations varied from hospital to hospital. (Korean J Clin Microbiol 2008;11:84-89)


Clarithromycin resistance, Helicobacter pylori, 23S rRNA mutation, Korea