Characteristics of phenotypic antibiotic resistance of Helicobacter pylori and its correlation with genotypic antibiotic resistance: A retrospective study in Ningxia

Abstract

Background Geographic differences exist in the antibiotic resistance patterns of Helicobacter pylori. Personalized treatment regimens based on local or individual resistance data are essential. We evaluated the current status of H. pylori resistance in Ningxia, analyzed resistance‐related factors, and assessed the concordance of phenotypic and genotypic resistance. Methods Strains were isolated from the gastric mucosa of patients infected with H. pylori in Ningxia and relevant clinical information was collected. Phenotypic antibiotic susceptibility assays (Kirby–Bauer disk diffusion) and antibiotic resistance gene detection (Sanger sequencing) were performed. Results We isolated 1955 H. pylori strains. The resistance rates of H. pylori to amoxicillin, levofloxacin, clarithromycin, and metronidazole were 0.9%, 42.4%, 40.4%, and 94.2%, respectively. Only five tetracycline‐resistant and one furazolidone‐resistant strain were identified. Overall, 3.3% of the strains were sensitive to all six antibiotics. Multidrug‐resistant strains accounted for 22.9%, of which less than 20% were from Wuzhong. Strains isolated from women and patients with nonulcerative disease had higher rates of resistance to levofloxacin and clarithromycin. Higher rates of resistance to metronidazole, levofloxacin, and clarithromycin were observed in the older age group than in the younger age group. The kappa coefficients of phenotypic resistance and genotypic resistance for levofloxacin and clarithromycin were 0.830 and 0.809, respectively, whereas the remaining antibiotics showed poor agreement. Conclusion H. pylori antibiotic resistance is severe in Ningxia. Therefore, furazolidone, amoxicillin, and tetracycline are better choices for the empirical therapy of H. pylori infection in this region. Host sex, age, and the presence of ulcerative diseases may affect antibiotic resistance of the bacteria. Personalized therapy based on genetic testing for levofloxacin and clarithromycin resistance may be a future direction for the eradication therapy of H. pylori infection in Ningxia.

Antibiotic resistance of Helicobacter pylori in Nanjing, China: a cross-section study from 2018 to 2023

“…This outcome aligns with prior research findings, reinforcing the validity and applicability of PCR as a reliable method for guiding treatment decisions related to levofloxacin. (Trespalacios-Rangel et al, 2016;Hu et al, 2023) Consistent with previous studies conducted in our nation, (Zhong et al, 2021) this investigation primarily focused on identifying point mutations occurring at amino acids 87 (resulting in substitutions from Asn to Lys, Ile, Try, or Arg) and 91 (resulting in substitutions from Asp to Asn, Gly, or Tyr) within the strains under examination. However, distinct from earlier studies, our research documented an added dimension by identifying 53 cases of gyrA double mutations and one instance of triple mutation.…”

Antibiotic resistance of Helicobacter pylori in Nanjing, China: A cross-section study from 2018 to 2023

“…This outcome aligns with prior research ndings, reinforcing the validity and applicability of ARMS-PCR as a reliable method for guiding treatment decisions related to levo oxacin. (20,21) Consistent with previous studies conducted in our nation, (14) This investigation primarily focused on identifying point mutations occurring at amino acids 87 (resulting in substitutions from Asn to Lys, Ile, Try, or Arg) and 91 (resulting in substitutions from Asp to Asn, Gly, or Tyr) within the strains under examination. However, distinct from earlier studies, our research documented an added dimension by identifying 53 cases of gyrA double mutations and one instance of triple mutation.…”

Real-World Situation of Eradication Regimens and Risk Factors for Helicobacter pylori Treatment in China: A Retrospective Single-Center Study

“… 27 Conversely, resistance rates for amoxicillin, tetracycline, and furazolidone remain low, underlining the potential of these antibiotics in maintaining high eradication rates. 28 Given the growing concern over antibiotic resistance, alternative strategies such as high-dose PPI and amoxicillin dual therapy have gained attention for their potential to reduce unnecessary antibiotic use while maintaining efficacy. 29 , 30 Our prior research supports this, demonstrating a 76.3% eradication rate with high-dose ilaprazole-amoxicillin dual therapy.…”