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Updated: Jul 21, 2025
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Antibiotic resistance and heteroresistance in Helicobacter pylori isolates from symptomatic Vietnamese children: A
Tu Cam Nguyen1,2, Giao Kim Ngoc Le3, Dao Thi Hong Pham4
1Department of Gastroenterology, City Children's Hospital, Ho Chi Minh City, Vietnam.
Insights
Antibiotic resistance in Helicobacter pylori is high in Vietnamese children, particularly for clarithromycin. This necessitates tailored treatment based on antimicrobial susceptibility testing.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Antibiotic resistance in Helicobacter pylori (H. pylori) is a growing global concern.
- Geographical variations in resistance impact treatment effectiveness.
- This study focuses on H. pylori antibiotic resistance patterns in Vietnamese children.
Purpose of the Study:
- To assess the antibiotic resistance patterns of H. pylori in symptomatic Vietnamese children.
- To identify common resistance profiles and genetic markers.
- To inform treatment strategies for H. pylori infections in this population.
Main Methods:
- Recruitment of symptomatic children undergoing gastroduodenoscopy in Ho Chi Minh City.
- Culture of H. pylori from antral and corpus biopsies.
- Antimicrobial susceptibility testing using E-test for amoxicillin, clarithromycin, metronidazole, levofloxacin, and tetracycline.
- PCR for virulence genes (cagA, vacA) and clarithromycin resistance mutations (23S rRNA).
Main Results:
- High primary resistance rates observed for clarithromycin (68.5%), levofloxacin (55.1%), and metronidazole (31.5%).
- Multidrug resistance was frequent (67.7%), with common patterns including clarithromycin + levofloxacin.
- The A2143G mutation conferring clarithromycin resistance was prevalent (97.5%).
Conclusions:
- Alarming rates of H. pylori antibiotic resistance, especially to clarithromycin, present a significant treatment challenge.
- Emerging multi- and hetero-resistant strains preclude the use of clarithromycin as empirical therapy.
- Utilizing biopsies from both antrum and corpus can enhance H. pylori culture and guide tailored antimicrobial susceptibility-based treatment.
Background:
Antibiotic resistance of Helicobacter pylori (H. pylori) is increasing worldwide, with geographical variations, impacting the treatment outcomes. This study assessed the antibiotic resistance patterns of H. pylori in Vietnamese children.
Materials And Methods:
Symptomatic children undergoing gastroduodenoscopy at two tertiary Children's Hospitals in Ho Chi Minh City were recruited. Antral and corpus biopsies were obtained and cultured separately. Susceptibility to amoxicillin (AMO), clarithromycin (CLA), metronidazole (MET), levofloxacin (LEV), and tetracycline (TET) was determined using E-test. Polymerase chain reaction was performed on another antral biopsy to detect the urease gene, cytotoxin-associated gene A (cagA), vacuolating cytotoxin A (vacA) genotypes, and 23S rRNA mutations conferring CLA resistance.
Results:
Among 123 enrolled children, a high primary resistance rate was found for CLA (68.5%, 61/89), followed by LEV (55.1%), MET (31.5%), AMO (25.8%), and TET (1.1%). Secondary resistance rates were 82.1% (7/28), 71.4%, 53.6%, and 3.6% for CLA, LEV, MET, and TET, respectively. Multidrug resistance was frequent (67.7%), with common patterns including CLA + LEV (20.3%) and CLA + MTZ + LEV (15.2%). Heteroresistance was detected in eight children (6.5%). The A2143G mutation was detected in 97.5% (119/122) of children. 86.1% of children had positive cagA strains and 27.9% had multiple vacA genotypes. No factor was significantly associated with antibiotic resistance.
Conclusions:
The alarming rate of antibiotic resistance for H. pylori, especially for CLA, with emerging multi- and hetero-resistant strains, pose a major treatment challenge that precludes CLA use as empirical therapy. Biopsies from both antrum and corpus can improve H. pylori culture, allowing tailored treatment based on antimicrobial susceptibility.
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