Sains Malaysiana 48(12)(2019): 2675–2682

http://dx.doi.org/10.17576/jsm-2019-4812-08

Helicobacter pylori Infection: Prevalence, Demographic Characteristics, Clarithromycin Resistance and Evaluation of the In-House Rapid Urease Test in Sungai Buloh Hospital, Malaysia

(Jangkitan Helicobacter pylori: Prevalens, Ciri Demografi, Kerintangan Klaritromisin dan Penilaian Ujian Pantas Urease Dalaman di Hospital Sungai Buloh, Malaysia)

NOR AKMAL MOKHTAR¹, NAJIHAN ABDUL SAMAT MUTTAQILLAH¹*, SALASAWATI HUSSIN¹, TUAN SUHAILA TUAN SOH², ZUBAIDAH ABDUL WAHAB² & MOHAMMAD SHUKRI JAHIT³

¹Department of Medical Microbiology & Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia

²Department of Pathology, Sungai Buloh Hospital, 47000 Sungai Buloh, Selangor Darul Ehsan, Malaysia

³Department of Surgery, Sungai Buloh Hospital, 47000 Sungai Buloh, Selangor Darul Ehsan, Malaysia

Received: 3 April 2019/Accepted: 23 September 2019

ABSTRACT

Helicobacter pylori infection remains an essential global research focus, and increasing clarithromycin resistance was reported to impact the efficacy of clarithromycin-based treatment regiments. The study objectives sought to understand the prevalence of H. pylori infection amongst patients from Sungai Buloh Hospital, Malaysia, its association with demographic factors, and the clarithromycin resistance rate. The in-house rapid urease test (IRUT) was also evaluated and compared to the Campylobacter-like organism (CLO) test using culture or histopathological testing as the gold standard for diagnosis. The gastric corpus biopsies of 352 patients were included, as well as their age group, gender and ethnicity. Clarithromycin susceptibility was measured using the E-test method. The overall prevalence of H. pylori infection was 15.1% (53/352). There was no significant association between the age groups, gender and ethnicity with regards to H. pylori infection. Four of the 13 viable isolates (30.8%) were clarithromycin-resistant. Although IRUT had a slightly lower specificity (94.9%) than that of the CLO test (95.9%), both tests had the same sensitivity values (81.1%). IRUT had a lower positive predictive value (74.1%) than the CLO test (78.2%) but showed a similar negative predictive value (96.5%) compared to the CLO test (96.6%). Both tests displayed a very good agreement (κ = 0.97). In conclusion, the overall prevalence of H. pylori infection in our study was generally low. The high proportion of clarithromycin-resistant isolates may not reflect the exact resistance rate due to the small number of positive cultures. Our IRUT is an acceptable alternative to the CLO test for the rapid diagnosis of H. pylori infections based on its comparable performance.

Keywords: Clarithromycin; Helicobacter pylori; rapid urease test

ABSTRAK

Jangkitan Helicobacter pylori kekal menjadi fokus penyelidikan global yang penting dan tahap kerintangan klaritromisin yang dilaporkan meningkat boleh memberi impak terhadap keberkesanan rejimen rawatan berasaskan klaritromisin. Objektif kajian ini adalah untuk mengkaji prevalens, sekutuan antara faktor demografi dan kadar kerintangan terhadap klaritromisin bagi jangkitan H. pylori dalam kalangan pesakit Hospital Sungai Buloh, Malaysia. Kami juga telah menilai dan membandingkan prestasi ujian pantas urease dalaman (IRUT) dengan ujian organisma seperti Campylobacter (CLO) menggunakan ujian kultur atau histopatologi sebagai piawai rujukan untuk diagnosis. Biopsi korpus gastrik daripada 352 pesakit telah dimasukkan dalam kajian ini dan data merangkumi kumpulan umur, jantina dan bangsa telah dianalisis. Kerentanan klaritromisin diukur menggunakan ujian E-test. Prevalens keseluruhan jangkitan H. pylori adalah 15.1% (53/352). Tiada sekutuan signifikan didapati antara jangkitan dan faktor demografi yang dikaji. Empat daripada 13 pencilan berdaya hidup (30.8%) adalah rintang klaritromisin. Walaupun ujian IRUT mempunyai kekhususan yang sedikit lebih rendah (94.9%) daripada ujian CLO (95.9%), namun kesensitifan kedua-dua ujian adalah sama (81.1%). Nilai ramalan positif ujian IRUT adalah lebih rendah (74.1%) berbanding ujian CLO (78.2%) namun nilai ramalan negatif hampir sama (96.5%) dengan ujian CLO (96.6%). Kedua-dua ujian menunjukkan persetujuan yang sangat baik (κ = 0.97). Kesimpulannya, prevalens keseluruhan jangkitan H. pylori dalam kajian kami pada umumnya adalah rendah. Kadar bilangan pencilan rintang klaritromisin yang tinggi mungkin tidak mencerminkan kadar rintangan sebenar memandangkan bilangan kultur positif yang sangat rendah. Prestasi ujian IRUT kami setanding dengan ujian CLO menjadikannya ujian alternatif yang boleh diterima sebagai ujian pantas bagi mengesan jangkitan H. pylori.

Kata kunci: Clarithromycin; Helicobacter pylori; ujian pantas urease

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*Corresponding author; email: muttaqillah@ppukm.ukm.edu.my