Antibiotic Resistance Landscape and Genomic Characterization of Helicobacter pylori in Western Inner Mongolia, China
Abstract
Abstract Background Helicobacter pylori (H. pylori) infection is associated with chronic gastritis, peptic ulcer, gastric cancer, and has been classified as a Group I carcinogen by the World Health Organization. With approximately 4.4 billion people infected globally, the increasing antibiotic resistance has become the leading cause of declining eradication rates, posing a major public health challenge. However, current treatment strategies in Western Inner Mongolia remain largely empirical due to the lack of region-specific resistance data. Objective To investigate the antibiotic resistance profiles of H. pylori in Western Inner Mongolia and characterize the genomic features of multidrug-resistant strains through whole-genome sequencing (WGS), thereby providing evidence for regionally adapted treatment strategies. Methods A total of 232 adult patients with H. pylori infection were enrolled from January 2020 to December 2022. Resistance-associated mutations in six antibiotics (clarithromycin, levofloxacin, amoxicillin, furazolidone, tetracycline, and metronidazole) were detected by PCR and Sanger sequencing. Among them, 69 isolates were successfully cultured for phenotypic antimicrobial susceptibility testing using the disk diffusion method. Furthermore, 20 phenotypically multidrug-resistant isolates were selected for WGS to analyze phylogenetic lineages, virulence factors, and gene ontology (GO) enrichment. CYP2C19 genotyping was also performed to evaluate proton pump…
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