Prevalence of Helicobacter pylori resistance to clarithromycin in Tunisia

Abstract

Background. Helicobacter pylori (H. pylori) resistance to clarithromycin is increasing worldwide. Data on the prevalence of H. pylori resistance are limited in Tunisia. Gap statement. Given that H. pylori 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. Aim. The aims were to define the prevalence of H. pylori infection among symptomatic patients and to determinate the level of clarithromycin resistance among these patients and the main mutations conferring this resistance. Methods. 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 H. pylori and ClariR PCR Assay. Results. Out of 124 biopsies, 101 (81.5 2 %) were PCR-positive for H. pylori . 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. Conclusion. Detection of more than 25 % of strains with clarithromycin resistance mutations makes the H. pylori first-line treatment with clarithromycin questionable in our setting, and a review of empirical treatment of H. pylori is urgently needed.

Prevalence of Clarithromycin-Resistant <i>Helicobacter pylori</i> Strains in Zambia: A Sub-Saharan African Country

“…Some African countries such as Egypt have reported rates of CLA resistance as high as 59% [19]. In Tunisia, the resistance rate was 32% [20], 36% in Sudan [21], 29% in Tanzania [22], 30% in Algeria [23], and 20% in South Africa [24]. These reports from other African countries demonstrate that our findings are not unique, but rather conform to the fact that CLA should not be used empirically for treatment of H. pylori infection in Africa.…”

Genetic Markers of <em>Helicobacter pylori </em>Antibiotic Resistance in Moscow

“…However, in some regions of the world, different nucleotide variants are encountered. For example, variants 2142G and 2143G are characteristic of Iran, Tunisia, Vietnam, and Russia [29][30][31]. T248C is characteristic of Myanmar, while for Sudan, in addition to 2142G and 2143G, variants T2182C and C2195T are also found [32,33].…”

“…For example, in the population of Myanmar, almost all levofloxacin-resistant isolates had an amino acid substitution at position 91 (Asp-91 to Asn or Tyr) and had no substitutions at codon However, levofloxacin-resistant strains in neighboring countries of Southeast Asia, such as Indonesia, Malaysia, and Cambodia, had both mutations [31]. Many studies have described single or double mutations at positions Asn87 and Asp91 as the most common mutation sites in resistant H. pylori isolates obtained from the gastric mucosa [34][35][36].…”