Characteristics of Helicobacter pylori Heteroresistance in Gastric Biopsies and Its Clinical Relevance

Abstract

BackgroundAntimicrobial susceptibility testing (AST) plays a vital role in anti-Helicobacter pylori treatment, but the traditional AST method has difficulty detecting heteroresistance, which may cause an increased prevalence of resistant strains and eradication failure.AimsTo investigate the characteristics of heteroresistance in H. pylori in gastric biopsies and investigate its clinical relevance.MethodA total of 704 gastric biopsies were selected for 23S rRNA and gyrA gene sequencing, 470 H. pylori isolates from these biopsies were selected for AST, and the clinical characteristics of the patients were reviewed.ResultFor the 699 biopsies that were positive for 23S rRNA gene, 98 (14.0%) showed a heteroresistance genotype, and a wild type (WT) combined with A2143G (86.7%) genotype was found in most samples. For the 694 biopsies that were positive for gyrA gene, 99 (14.3%) showed a heteroresistance genotype, and a WT combined with 87K (26.3%) or WT combined with 91N (23.2%) genotype was predominant. According to the E-test results, the resistance rates of heteroresistance genotype samples for clarithromycin and levofloxacin were 36.2% and 68.1%, respectively. When dividing the heteroresistance samples into different groups according to the sequencing profile peaks of the mutation position, the resistance rates were higher along with mutation peaks at the mutation position. In addition, patients infected with mutated or heteroresistant strains showed lower peptic ulcer detection rates than those infected with the WT strain (p < 0.05).ConclusionHeteroresistance genotypes for clarithromycin and levofloxacin were not rare in H. pylori. Most cases with a heteroresistance genotype showed a susceptible phenotype for clarithromycin and a resistance phenotype for levofloxacin. Patients infected with heteroresistance genotype strains showed a lower peptic ulcer detection rate than those infected with the WT strain.

Efficacy of genotypic susceptibility‐guided tailored therapy for Helicobacter pylori infection: A systematic review and single arm meta‐analysis

“…59,60 It was reported that heteroresistance to clarithromycin, levofloxacin, and metronidazole is not rare in H. pylori. 61,62 In our results, the efficacy of tailored BQT seemed to be comparable to tailored triple therapy (88.3% vs. 88.9% by ITT analysis and 93.2% vs. 92.8% by PP analysis) (Table 4). This result should be treated with caution, as triple therapy is often used for primary treatment, while BQT is usually also used for rescue treatment.…”

“…On the other hand, heteroresistance of H. pylori may also affect the efficacy of TT for the reason that both susceptible and resistant strains can be simultaneously present in different sites of a single stomach and that antibiotic susceptibility may change during treatment 59,60 . It was reported that heteroresistance to clarithromycin, levofloxacin, and metronidazole is not rare in H. pylori 61,62 …”

Gastroprotective and anti-Helicobacter pylori potentials of essential oils from the oleoresins of Araucaria bidwillii and Araucaria heterophylla

“…Helicobacter pylori , a gram-negative bacterium, can affect the stomach leading to oxidative stress state which plays main role in the pathogenesis of peptic ulcers (Wang et al 2022 ). The inhibitory potential of both EOs against H. pylori activity was assessed in vitro.…”

Helicobacter pylori infection

“…H. pylori colonies may carry single-drug, multidrug or hetero resistance 296,297 . Isolates from antrum and corpus are reported to differ by up to 15% in AST, which may account for treatment failure if biopsy samples for AST are only taken from a single site in the stomach 298,299 .…”