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Long-Term Persistence of Resistant Enterococcus Species after Antibiotics To Eradicate Helicobacter pylori

Maria Sjölund, MSc; Karin Wreiber, MSc; Dan I. Andersson, PhD; Martin J. Blaser, MD; and Lars Engstrand, MD
[+] Article and Author Information

From University Hospital Uppsala, Uppsala, and The Swedish Institute for Infectious Disease Control, Solna, Sweden; and New York University School of Medicine, New York, New York.


Acknowledgments: The authors thank Lena Zimmergren for coordinating the collection of samples and Lena Eriksson and Kristina Schönmeyr for excellent technical assistance.

Grant Support: By the AFA Health Research Foundation, Stockholm, Sweden, and by the National Institutes of Health (RO1GM63270).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Lars Engstrand, MD, Department of Bacteriology, Swedish Institute for Infectious Disease Control, SE-171 82 Solna, Sweden; e-mail, lars.engstrand@smi.ki.se.

Current Author Addresses: Ms. Sjölund: Department of Medical Sciences, Clinical Bacteriology, University Hospital Uppsala, Box 552, SE-751 22 Uppsala, Sweden.

Ms. Wreiber and Drs. Andersson and Engstrand: Department of Bacteriology, Swedish Institute for Infectious Disease Control, SE-171 82 Solna, Sweden.

Dr. Blaser: Departments of Medicine and Microbiology, New York University School of Medicine, New York, NY 10016.

Author Contributions: Conception and design: M. Sjölund, L. Engstrand.

Analysis and interpretation of the data: M. Sjölund, D.I. Andersson, M.J. Blaser, L. Engstrand.

Drafting of the article: M. Sjölund, D.I. Andersson, M.J. Blaser, L. Engstrand.

Critical revision of the article for important intellectual content: M. Sjölund, D.I. Andersson, M.J. Blaser, L. Engstrand.

Final approval of the article: M. Sjölund, K. Wreiber, D.I. Andersson, M.J. Blaser, L. Engstrand.

Provision of study materials or patients: K. Wreiber.

Obtaining of funding: L. Engstrand.

Administrative, technical, or logistic support: K. Wreiber, L. Engstrand.

Collection and assembly of data: K. Wreiber, L. Engstrand.


Ann Intern Med. 2003;139(6):483-487. doi:10.7326/0003-4819-139-6-200309160-00011
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Background: Antibiotic treatment selects for resistance not only in the pathogen to which it is directed but also in the indigenous microflora.

Objective: To determine whether a widely used regimen (clarithromycin, metronidazole, and omeprazole) for Helicobacter pylori eradication affects resistance development in enterococci.

Design: Cohort study.

Setting: Endoscopy units at 3 community hospitals in Sweden.

Patients: 5 consecutive dyspeptic patients who were colonized with H. pylori, had endoscopy-confirmed duodenal ulcer, and received antibiotic treatment, and 5 consecutive controls with dyspepsia but no ulcer who did not receive treatment.

Measurements: Fecal samples were obtained from patients and controls before, immediately after, 1 year after, and 3 years after treatment. From each patient and sample, enterococci were isolated and analyzed for DNA fingerprint, clarithromycin susceptibility, and presence of the erm(B) gene.

Results: In treated patients, all enterococci isolated immediately after treatment showed high-level clarithromycin resistance due to erm(B). In 3 patients, resistant enterococci persisted for 1 to 3 years after treatment. No resistance developed among controls.

Conclusion: A common H. pylori treatment selects for highly resistant enterococci that can persist for at least 3 years without further selection.

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Summary for Patients

Effects of Antibiotic Treatment for Helicobacter pylori on Normal Bowel Bacteria

The summary below is from the full report titled “Long-Term Persistence of Resistant Enterococcus Species after Antibiotics To Eradicate Helicobacter pyori.” It is in the 16 September 2003 issue of Annals of Internal Medicine (volume 139, pages 483-487). The authors are M. Sjölund, K. Wreiber, D.I. Andersson, M.J. Blaser, and L. Engstrand.

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