Microbiology laboratory/UR04SP08 Rabta University Hospital-Tunis, 1007 El Jabbari, Tunisia.
Ann Clin Microbiol Antimicrob. 2010 Aug 13;9:22. doi: 10.1186/1476-0711-9-22.
The frequency of primary resistance to antibiotics in H. pylori isolates is increasing worldwide. In Tunisia, there are limited data regarding the pattern of H. pylori antibiotic primary resistance.
To evaluate the primary resistance of H. pylori to clarithromycin, metronidazole and amoxicillin and to detect the mutations involved in clarithromycin resistance.
273 strains isolated from adults and children were enrolled. The primary resistance to clarithromycin, metronidazole and amoxicillin was evaluated by means of E-test minimal inhibitory concentration (MIC). The real-time PCR using Scorpion primers was performed in all cases to assess clarithromycin primary resistance and point mutations involved.
No resistance to amoxicillin was detected. For adults, resistance to clarithromycin and metronidazole was found respectively in 14.6% and 56.8%, and respectively in 18.8% and 25% in children. Overall, the rates of global primary resistance to clarithromycin and metronidazole in Tunisia were respectively determined in 15.4% and 51.3%.By the use of Scorpion PCR, the A2143G was the most frequent point mutation observed (88.1%), followed by the A2142G (11.9%); the A2142C was not found and 18 of 42 patients (42.8%) were infected by both the resistant and the susceptible genotype.The association of clarithromycin resistance with gender was not statistically significant, but metronidazole resistant strains were isolated more frequently in females (67.8%) than in males (32.2%) and the difference was significant. As for gastroduodenal diseases, the difference between strains isolated from patients with peptic ulceration and those with non peptic ulceration was not statistically significant. When about the distribution of resistant strains to clarithromycin and metronidazole between the three Tunisian cities (Tunis, Menzel Bourguiba and Mahdia), the difference was not statistically significant.
Local data regarding the primary resistance of H. pylori to clarithromycin, metronidazole and amoxicillin and the main genetic mutation involved in clarithromycin resistance in vivo (A2143G) are necessary to prove a clear need for a periodic evaluation of antibiotic consumption and new therapeutic strategies in Tunisia in order to avoid the emergence of resistant strains.
全球范围内，幽门螺杆菌分离株对抗生素的原发耐药率不断升高。在突尼斯，有关幽门螺杆菌抗生素原发耐药模式的数据有限。
评估幽门螺杆菌对克拉霉素、甲硝唑和阿莫西林的原发耐药率，并检测克拉霉素耐药相关的突变。
纳入 273 株成人和儿童分离株。采用 E 试验最小抑菌浓度（MIC）评估克拉霉素、甲硝唑和阿莫西林的原发耐药性。对所有病例进行实时 PCR 采用 Scorpion 引物，以评估克拉霉素原发耐药性和涉及的点突变。
未检测到阿莫西林耐药。成人中，克拉霉素和甲硝唑的耐药率分别为 14.6%和 56.8%，儿童中分别为 18.8%和 25%。总体而言，突尼斯的全球克拉霉素和甲硝唑原发耐药率分别为 15.4%和 51.3%。通过 Scorpion PCR，发现最常见的点突变是 A2143G（88.1%），其次是 A2142G（11.9%）；未发现 A2142C，42 例患者中有 18 例（42.8%）感染了耐药和敏感基因型。克拉霉素耐药与性别无关，但甲硝唑耐药株在女性（67.8%）中比男性（32.2%）更常见，差异有统计学意义。就胃十二指肠疾病而言，消化性溃疡和非消化性溃疡患者分离株之间的克拉霉素耐药率无统计学差异。当比较来自突尼斯三个城市（突尼斯、本·阿里和马赫迪耶）的克拉霉素和甲硝唑耐药株的分布时，差异无统计学意义。
有关幽门螺杆菌对克拉霉素、甲硝唑和阿莫西林的原发耐药率以及体内克拉霉素耐药的主要遗传突变（A2143G）的本地数据对于证明在突尼斯定期评估抗生素的使用和新的治疗策略的明确需求是必要的，以避免耐药株的出现。
