Phenotypic and genotypic analysis of Helicobacter pylori resistance patterns, molecular characteristics, and CYP2C19 polymorphisms in Nanjing: a retrospective cross-sectional study
Abstract
BACKGROUND: The continued rise in antibiotic resistance of Helicobacter pylori (H. pylori) poses a major challenge to clinical eradication therapy. The resistance patterns and phenotype-genotype concordance of H. pylori in the Nanjing region have not been systematically reported in recent years.
METHODS: Data from 7227 enrolled patients at Nanjing First Hospital (2018-2024) were retrospectively analyzed. Among these, 5729 patients were culture-positive for H. pylori and underwent phenotypic antimicrobial susceptibility testing for six antibiotics. Genotypic testing for resistance-associated mutations was performed on a subset of these patients. The remaining 1498 patients, although H. pylori-positive by other diagnostic methods, were culture-negative and were excluded from resistance analyses.
RESULTS: Metronidazole showed the highest resistance rate at 84.45% (4838/5729, 95% CI: 83.50-85.37), followed by clarithromycin at 50.01% (2865/5729, 95% CI: 48.71-51.31) and levofloxacin at 38.59% (2211/5729, 95% CI: 37.33-39.87). Resistance rates to amoxicillin at 0.51% (29/5729, 95% CI: 0.34-0.73), furazolidone at 0.19% (11/5729, 95% CI: 0.10-0.34), and tetracycline at 0.07% (4/5729, 95% CI: 0.02-0.18) were very low. Annual trend analysis showed that the metronidazole resistance rate remained above 92% since 2020, reaching 98.68% in 2024. Clarithromycin resistance increased from 35.80% to 60.14% and then declined slightly, while levofloxacin resistance rose from 20.99% to 44.59%…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 7,227 participants or records.
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