Dossouvi Komla Mawunyo, Bouyo Tchilabalo, Sognonnou Simon, Ibadin Ephraim Ehidiamen, Lv Lu-Chao, Sambe Ba Bissoume, Seck Abdoulaye, Dossim Sika, Sellera Fábio Parra, Camara Makhtar, El Kelish Amr, Smith Stella Ifeanyi
Department of Microbiology, Global Health Research Institute, Lomé, Togo.
Laboratoire des Sciences Biomédicales Alimentaires et de Santé Environnementale, Ecole Supérieure des Techniques Biologiques et Alimentaires, Université de Lomé, Lomé, Togo.
Antimicrob Resist Infect Control. 2025 Apr 12;14(1):31. doi: 10.1186/s13756-025-01533-6.
In 2022, approximately 56.5% of adults and 47.1% of children and adolescents were affected by Helicobacter pylori (H. pylori) infection in Africa, and clarithromycin-resistant H. pylori (CRHp) strains have become global priority pathogens. Therefore, this study aimed to conduct the first comprehensive systematic review and meta-analysis of CRHp in Africa.
This investigation was conducted according to the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (The PRISMA 2020). Literature search of electronic databases (Google Scholar, African Journals Online, ResearchGate, PubMed, Embase, and Scopus) was performed using keywords "clarithromycin", "Helicobacter pylori", "African country name", "mutation in the 23S rRNA".
Sixty-five studies involving 5,313 H. pylori strains isolated over 26 years (1997-2022) from 23 African countries were included in this study. The samples from which CRHp was isolated included gastric biopsy (60/63; 95%), and stool (4/63; 6%). The pooled prevalence of CRHp in Africa was 27% (95% CI: 22, 33). There was a steady trend in the prevalence of CRHp isolated in Africa over the 26 years (R = 0.0001, p = 0.92, slope coefficient of -0.05x). Ten types of 23S rRNA mutations (conferring clarithromycin resistance) were identified, and included mainly A2143G (465 H. pylori strains out of 1178 tested) and A2142G (344 H. pylori strains out of 1027).
To enhance the accuracy and validity of surveillance data for H. pylori in Africa, there is an urgent need for implementing standardized microbiological methods for resistance detection. The prevalence of CRHp reported in this study was very similar to the overall global prevalence and there is a need for more representative studies on CRHp in Africa. While waiting for this, the treatment of H. pylori infections must be based on the guidelines of the AHMSG first Lagos consensus.
2022年，非洲约56.5%的成年人以及47.1%的儿童和青少年受到幽门螺杆菌（H. pylori）感染影响，而对克拉霉素耐药的幽门螺杆菌（CRHp）菌株已成为全球重点关注的病原体。因此，本研究旨在对非洲的CRHp进行首次全面的系统评价和荟萃分析。
本调查按照系统评价和荟萃分析的首选报告项目（PRISMA 2020）指南进行。使用关键词“克拉霉素”“幽门螺杆菌”“非洲国家名称”“23S rRNA中的突变”对电子数据库（谷歌学术、非洲在线期刊、ResearchGate、PubMed、Embase和Scopus）进行文献检索。
本研究纳入了65项研究，涉及26年（1997 - 2022年）间从23个非洲国家分离出的5313株幽门螺杆菌菌株。分离出CRHp的样本包括胃活检样本（60/63；95%）和粪便样本（4/63；6%）。非洲CRHp的合并患病率为27%（95%置信区间：22，33）。在这26年中，非洲分离出的CRHp患病率呈稳定趋势（R = 0.0001，p = 0.92，斜率系数为 -0.05x）。鉴定出10种23S rRNA突变（赋予克拉霉素耐药性），主要包括A2143G（1178株检测的幽门螺杆菌中有465株）和A2142G（1027株中有344株）。
为提高非洲幽门螺杆菌监测数据的准确性和有效性，迫切需要实施标准化的微生物耐药检测方法。本研究报告的CRHp患病率与全球总体患病率非常相似，并且需要对非洲的CRHp开展更具代表性的研究。在此期间，幽门螺杆菌感染的治疗必须基于AHMSG拉各斯首次共识指南。
