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Updated: Apr 30, 2026
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Virulence factors and antibiotic resistance in children with Helicobacter pylori gastritis
Hamza Karabiber1, Mukadder A Selimoglu, Baris Otlu
1*Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition †Department of Clinical Microbiology ‡Department of Public Health, Inonu University, Faculty of Medicine, Malatya, Turkey.
Insights
Helicobacter pylori (Hp) antibiotic resistance and virulence factors in children are not well-documented. This study found that specific Hp genotypes, cagE and vacA s1a/m2, were common and linked to increased antibiotic resistance in pediatric patients.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Molecular epidemiology
Background:
- Limited data exist on Helicobacter pylori (Hp) antibiotic resistance and virulence factors in pediatric populations.
- Understanding these factors is crucial for effective treatment and management of Hp gastritis in children.
Purpose of the Study:
- To evaluate the prevalence of drug resistance and virulence-factor genotypes in children with Hp gastritis.
- To investigate the relationship between antibiotic resistance and specific Hp genotypes in this age group.
Main Methods:
- Ninety-eight children with confirmed Hp gastritis underwent analysis.
- Antimicrobial susceptibility testing used the disc diffusion method.
- Polymerase chain reaction (PCR) assays identified virulence factors and specific genotypes.
Main Results:
- High resistance rates were observed for clarithromycin (23.5%), metronidazole (11.7%), and amoxicillin (3.9%).
- All strains possessed the vacA genotype; common virulence factors included cagE (70.4%) and babA2 (49%).
- Clarithromycin resistance was significantly associated with cagE, iceA1, babA2, and vacAs1c positivity; metronidazole resistance was linked to vacAs1 and vacAs1c.
Conclusions:
- The cagE-positive and vacA s1a/m2 genotypes were predominant and correlated with increased antibiotic resistance in the studied pediatric population.
- These findings highlight the importance of monitoring Hp virulence factors and antibiotic susceptibility in children.
- Such studies can aid in predicting prognosis and reducing morbidity and mortality associated with Hp infections in high-prevalence regions.
Objectives:
There are limited data regarding the pattern of Helicobacter pylori (Hp) antibiotic resistance and virulence factors in children. Evaluation of prevalence of drug resistance and virulence-factor genotype in children with Hp gastritis and to investigate whether there is any relation between drug resistance and genotype were our aims in this study.
Methods:
Ninety-eight children with polymerase chain reaction-positive Hp gastritis were included. Antimicrobial susceptibility was tested by disc diffusion method and polymerase chain reaction assays were used for the determination of virulence factors.
Results:
The resistance rates to clarithromycin, metronidazole, and amoxicillin were 23.5%, 11.7%, and 3.9%, respectively. All strains carried vacA genotype, and 51%, 70.4%, 49%, 34.7%, and 25.5% were cagA-, cagE-, babA2-, iceA1-, and iceA2-positive, respectively. Of those 98 specimens, 81.6%, 19.4%, 38.8%, and 63.3% carried vacAs1, vacAs2, vacAm1, and vacAm2, respectively. Dominant vacA type was s1am2 (32.7%), followed by s1am1 (14.3%) and s2m2 (12.2%). Significant rates of clarithromycin resistance were observed in cagE-, iceA1-, babA2-, and vacAs1c-positive groups. In those with metronidazole resistance, vacAs1 and vacAs1c were more common (P < 0.05).
Conclusions:
The cagE-positive and vacA s1a/m2 genotypes, which are correlated with increased antibiotic resistance, were predominant in our population. In countries where Hp infection is prevalent, studies focusing on virulence factors and antibiotic susceptibility may provide anticipation of the prognosis and may be helpful to reduce morbidity and mortality.
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