摘要

关于局部抗生素耐药性的知识对于适应幽门螺杆菌感染的有效经验性一线治疗的选择是至关重要的。这项研究的目的是首次在摩洛哥评估幽门螺杆菌对克拉霉素，甲硝唑，阿莫西林，左氧氟沙星，四环素和利福霉素的主要耐药性的流行率。我们进行了一项为期一年的前瞻性研究（2015年），其中包括255名摩洛哥患者转诊为胃十二指肠内窥镜检查，前往拉巴特（摩洛哥）的两家医院，以前从未接受H. pylori感染治疗。收集三个胃活检组织：一个用于组织学，一个用于培养，另一个用于幽门螺杆菌的分子检测以及赋予对克拉霉素抗性的23S rRNA基因的突变。通过Etest和纸片扩散方法对分离的菌株进行抗微生物敏感性测试。一百七十七名病人被感染（69.4％）。幽门螺杆菌对克拉霉素的原发耐药率为29％，甲硝唑为40％，阿莫西林，四环素和利福霉素为0％，左氧氟沙星为11％。只有四种分离物（2％）对克拉霉素和甲硝唑都有抗性。幽门螺杆菌菌株对摩洛哥人群的高克拉霉素耐药性导致我们建议放弃标准克拉霉素为基础的三联疗法作为摩洛哥的一线治疗方案，并希望采用伴随四联疗法。

Knowledge of local antibiotic resistance is crucial to adaption of the choice of effective empirical first-line treatment forHelicobacter pylori infection. The aim of this study was to evaluate, for the first time in Morocco, the prevalence of the primary resistance of H. pylori to clarithromycin, metronidazole, amoxicillin, levofloxacin, tetracycline, and rifamycin. We conducted a 1-year prospective study (2015), including 255 Moroccan patients referred for gastro-duodenal endoscopy to two hospitals of Rabat (Morocco) and never previously treated for H. pylori infection. Three gastric biopsies were collected: one for histology, one for culture, and one for molecular detection of H. pylori and the mutations in 23S rRNA genes that confer resistance to clarithromycin. Antimicrobial susceptibility testing was performed on isolated strains by Etest and disk diffusion methods. One hundred seventy-seven patients were infected (69.4%). The prevalence of primary resistances of H. pylori to clarithromycin was 29%, 40% to metronidazole, 0% to amoxicillin, tetracycline, and rifamycin, and 11% to levofloxacin. Only four isolates (2%) were resistant to both clarithromycin and metronidazole. The high level of primary clarithromycin resistance in the H. pylori strains infecting the Moroccan population leads us to recommend the abandonment of the standard clarithromycin-based triple therapy as a first-line treatment in Morocco and to prefer a concomitant quadruple therapy.

https://www.liebertpub.com/doi/abs/10.1089/mdr.2016.0264