Analysis of Helicobacter pylori Resistance and Its Trends in Chongqing: A 10-Year Retrospective Study

The high rates of Helicobacter pylori resistance to antibiotics and increasing eradication failure have received much attention worldwide.

Gastric mucosa specimens were collected from 7,921 patients with H. pylori infection confirmed by urea breath test from January 2015 to December 2024. H. pylori isolation and culture were performed, followed by antimicrobial susceptibility testing.

The overall and multidrug resistance (MDR) rates of the 5,205 H. pylori isolates to antibiotics were 95.93% and 18.83%, respectively. The listed antibiotic resistance rates in descending order were metronidazole (94.33%), levofloxacin (36.14%), clarithromycin (32.10%), amoxicillin (0.48%), and furazolidone or tetracycline (0%). The analysis demonstrated no significant difference between resistance rates for periods 2015-2019 (95.90%) and 2020-2024 (96.11%) (p > 0.05). Resistance rates differed significantly between the two periods: levofloxacin (35.33% vs. 41.62%), clarithromycin (27.86% vs. 60.93%), and amoxicillin (0.33% vs. 1.50%) (p < 0.05). The MDR rates increased significantly from 16.75% in 2015-2019 to 32.93% in 2020-2024 (p < 0.001). Treatment-experienced patients demonstrated elevated resistance levels and MDR rates (99.31% and 39.45%) in comparison to treatment-naïve individuals (94.99% and 15.02%; p ≤ 0.001). Besides, treatment-experienced patients exhibited significantly higher resistance rates to metronidazole (97.92%), clarithromycin (67.47%), levofloxacin (46.02%), and amoxicillin (1.04%) compared to treatment-naïve patients (92.54%, 32.07%, 35.04%, 0%; p < 0.001).

The study revealed elevated overall resistance rates and MDR rates of H. pylori to metronidazole, clarithromycin, and levofloxacin, with significantly higher rates observed in treatment-experienced patients. Notably, a rising pattern in resistance rates to levofloxacin, clarithromycin, amoxicillin, and MDR rates was observed in recent years.