The application of genotypic resistance testing for clarithromycin and levofloxacin in different types of Helicobacter pylori infected patients based on gastric mucosal samples
Abstract
Objective: To evaluate the utility of genotypic resistance testing for specific antibiotics in both treatment-naïve and rescue patients with Helicobacter pylori infection, providing a basis for the rational selection of patients suitable for individualized therapy. Methods: This was a single-center cross-sectional study performed between January 2024 and July 2025 involving 385 patients with active H. pylori infection. Participants were stratified into treatment-naïve or previously treated cohorts according to their eradication history. During endoscopy, paired biopsies were obtained from corresponding sites in the gastric antrum and body; one specimen was used for the qPCR-based detection of mutations in the 23S rRNA and gyrA genes, while the other was reserved for H. pylori culture with antimicrobial susceptibility testing to determine minimum inhibitory concentrations (MICs). Resistance was interpreted according to EUCAST (v.15.0) breakpoints. Categorical variables were compared using the χ2 test or Fisher's exact test. Agreement between genotypic and phenotypic resistance was assessed using the concordance rate and the Kappa statistic. Results: Genotypic resistance rates for clarithromycin and levofloxacin increased stepwise with previous treatment exposure. Clarithromycin genotypic resistance rates in the treatment-naïve, retreatment, and refractory groups were 50.7% (109/215), 75.7% (53/70), and 93.8% (91/97), respectively (χ2=59.01, P<0.001). For levofloxacin, the…
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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.
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