1887

Journal of Medical Microbiology logo

Volume 71, Issue 8

Prevalence of resistance to clarithromycin in Tunisia No Access

Abstract

(H. pylori) resistance to clarithromycin is increasing worldwide. Data on the prevalence of resistance are limited in Tunisia.

Given that resistance to clarithromycin has not been studied in Tunisia since 2010, there was a need to determinate its prevalence and the principal mutations implicated in this resistance.

The aims were to define the prevalence of infection among symptomatic patients and to determinate the level of clarithromycin resistance among these patients and the main mutations conferring this resistance.

We conducted a cross-sectional study from March 2017 to February 2020 in the Hepato-Gastroenterology Department of Hedi Chaker University Hospital in Sfax that included 124 Tunisian patients who underwent gastroduodenal endoscopy with biopsies. Mutations conferring resistance to clarithromycin were detected using the Allplex and ClariR PCR Assay.

Out of 124 biopsies, 101 (81.5 2 %) were PCR-positive for . Mutations conferring resistance to clarithromycin were detected in 30/95 (31.6 %) of patients. The rate of primary resistance was 25.3 % and of secondary resistance 62.5 %. The most frequently detected mutation was A2143G (86, 90%) followed by A2142G (11, 36%). Seven patients had a double mutation A2143G–A2142G. The factors independently associated with resistance to clarithromycin were diabetes, high blood pressure, the presence of a bulbar ulcer on endoscopy and the presence of gastric atrophy on histology.

Detection of more than 25 % of strains with clarithromycin resistance mutations makes the first-line treatment with clarithromycin questionable in our setting, and a review of empirical treatment of is urgently needed.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): antibiotics , clarithromycin , Helicobacter pylori and resistance
© 2022 The Authors
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.001561
2022-08-25
2024-05-03
Loading full text...

Full text loading...

References

  1. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984; 1:1311–1315 [View Article] [PubMed]
     [Google Scholar]
  2. Ahmed N. 23 years of the discovery of Helicobacter pylori: is the debate over?. Ann Clin Microbiol Antimicrob 2005; 4:17 [View Article] [PubMed]
     [Google Scholar]
  3. Smith S, Fowora M, Pellicano R. Infections with Helicobacter pylori and challenges encountered in Africa. World J Gastroenterol 2019; 25:3183–3195 [View Article] [PubMed]
     [Google Scholar]
  4. de Brito BB, da Silva FAF, Soares AS, Pereira VA, Santos MLC et al. Pathogenesis and clinical management of Helicobacter pylori gastric infection. World J Gastroenterol 2019; 25:5578–5589 [View Article] [PubMed]
     [Google Scholar]
  5. Baradaran Ghavami S, Chaleshi V, Derakhshani S, Aimzadeh P, Asadzadeh-Aghdaie H et al. Association between TNF-α rs1799964 and RAF1 rs1051208 MicroRNA binding site SNP and gastric cancer susceptibility in an Iranian population. Gastroenterol Hepatol Bed Bench 2017; 10:214–219 [PubMed]
     [Google Scholar]
  6. Sanches BS, Martins GM, Lima K, Cota B, Moretzsohn LD et al. Detection of Helicobacter pylori resistance to clarithromycin and fluoroquinolones in Brazil: a national survey. World J Gastroenterol 2016; 22:7587–7594 [View Article] [PubMed]
     [Google Scholar]
  7. Pichon M, Pichard B, Barrioz T, Plouzeau C, Croquet V et al. Diagnostic accuracy of a noninvasive test for detection of Helicobacter pylori and resistance to clarithromycin in stool by the amplidiag H. pylori+ClariR real-time PCR assay. J Clin Microbiol 2020; 58:e01787-19 [View Article] [PubMed]
     [Google Scholar]
  8. Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ et al. Management of Helicobacter pylori infection-the Maastricht V/Florence consensus report. Gut 2017; 66:6–30 [View Article] [PubMed]
     [Google Scholar]
  9. Ghotaslou R, Leylabadlo HE, Asl YM. Prevalence of antibiotic resistance in Helicobacter pylori: a recent literature review. World J Methodol 2015; 5:164–174 [View Article] [PubMed]
     [Google Scholar]
  10. Giorgio F, Principi M, De Francesco V, Zullo A, Losurdo G et al. Primary clarithromycin resistance to Helicobacter pylori: is this the main reason for triple therapy failure?. World J Gastrointest Pathophysiol 2013; 4:43–46 [View Article] [PubMed]
     [Google Scholar]
  11. Jaka H, Rhee JA, Östlundh L, Smart L, Peck R et al. The magnitude of antibiotic resistance to Helicobacter pylori in Africa and identified mutations which confer resistance to antibiotics: systematic review and meta-analysis. BMC Infect Dis 2018; 18:193 [View Article] [PubMed]
     [Google Scholar]
  12. Ben Mansour K, Burucoa C, Zribi M, Masmoudi A, Karoui S et al. Primary resistance to clarithromycin, metronidazole and amoxicillin of Helicobacter pylori isolated from Tunisian patients with peptic ulcers and gastritis: a prospective multicentre study. Ann Clin Microbiol Antimicrob 2010; 9:22 [View Article] [PubMed]
     [Google Scholar]
  13. Jaka H, Rüttgerodt N, Bohne W, Mueller A, Gross U et al. Helicobacter pylori mutations conferring resistance to fluoroquinolones and clarithromycin among dyspeptic patients attending a Tertiary Hospital, Tanzania. Can J Gastroenterol Hepatol 2019; 2019:8481375 [View Article]
     [Google Scholar]
  14. Ménard A, Santos A, Mégraud F, Oleastro M. PCR-restriction fragment length polymorphism can also detect point mutation A2142C in the 23S rRNA gene, associated with Helicobacter pylori resistance to clarithromycin. Antimicrob Agents Chemother 2002; 46:1156–1157 [View Article] [PubMed]
     [Google Scholar]
  15. Espinoza MGC, Vazquez RG, Mendez IM, Vargas CR, Cerezo SG. Detection of the glmM gene in Helicobacter pylori isolates with a novel primer by PCR. J Clin Microbiol 2011; 49:1650–1652 [View Article] [PubMed]
     [Google Scholar]
  16. Ghizlane B, Hasna B, Saloua N, Mohamed RJ, Mariem B et al. Epidemiology of Helicobacter pylori infection and related gastric pathologies in Moroccan population. J Life Sci 2017; 11: [View Article]
     [Google Scholar]
  17. Jmaa R, Aissaoui B, Golli L, Jmaa A, Qaddi JA et al. Les particularités de la gastrite chronique à Hélicobacter pylori au centre ouest de la Tunisie. Tunis Med 2010; 88:5
     [Google Scholar]
  18. Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization regions. Gastroenterology 2018; 155:1372–1382 [View Article] [PubMed]
     [Google Scholar]
  19. Bouilhat N, Burucoa C, Benkirane A, El Idrissi-Lamghari A, Al Bouzidi A et al. High-level primary clarithromycin resistance of Helicobacter pylori in Morocco: a prospective multicenter molecular study. Helicobacter 2015; 20:422–423 [View Article] [PubMed]
     [Google Scholar]
  20. Djennane-Hadibi F, Bachtarzi M, Layaida K, Ali Arous N, Nakmouche M et al. High-level primary clarithromycin resistance of Helicobacter pylori in Algiers, Algeria: a prospective multicenter molecular study. Microb Drug Resist 2016; 22:223–226 [View Article] [PubMed]
     [Google Scholar]
  21. Bachir M, Allem R, Tifrit A, Medjekane M, Drici A-M et al. Primary antibiotic resistance and its relationship with cagA and vacA genes in Helicobacter pylori isolates from Algerian patients. Braz J Microbiol 2018; 49:544–551 [View Article] [PubMed]
     [Google Scholar]
  22. Lopo I, Libânio D, Pita I, Dinis-Ribeiro M, Pimentel-Nunes P. Helicobacter pylori antibiotic resistance in Portugal: systematic review and meta-analysis. Helicobacter 2018; 23:e12493 [View Article] [PubMed]
     [Google Scholar]
  23. Megraud F, Coenen S, Versporten A, Kist M, Lopez-Brea M et al. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut 2013; 62:34–42 [View Article] [PubMed]
     [Google Scholar]
  24. Jehanne Q, Bénéjat L, Mégraud F, Bessède E, Lehours P. Evaluation of the AllplexTM H. pylori and ClariR PCR assay for Helicobacter pylori detection on gastric biopsies. Helicobacter 2020; 25:e12702 [View Article] [PubMed]
     [Google Scholar]
  25. Kocsmár É, Kocsmár I, Buzás GM, Szirtes I, Wacha J et al. Helicobacter pylori heteroresistance to clarithromycin in adults—New data by in situ detection and improved concept: 11. n.d
  26. Khien VV, Thang DM, Hai TM, Duat NQ, Khanh PH et al. Management of antibiotic-resistant Helicobacter pylori infection: perspectives from Vietnam. Gut Liver 2019; 13:483–497 [View Article] [PubMed]
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.001561
Loading
Prevalence of Helicobacter pylori resistance to clarithromycin in Tunisia
J. Med. Microbiol. 71, 001561 (2022); https://doi.org/10.1099/jmm.0.001561
/content/journal/jmm/10.1099/jmm.0.001561
/content/journal/jmm/10.1099/jmm.0.001561
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error