Predictors of Resistance in Pediatric Helicobacter pylori Infection

Helicobacter pylori (H. pylori) antimicrobial resistance is a key driver of eradication failure in children and adults. Recognizing factors associated with H. pylori antimicrobial resistance may help identify individuals at risk for treatment failure and tailor management. We conducted a retrospective cohort study of patients with H. pylori-positive gastric biopsy culture and available antimicrobial susceptibility data at a large pediatric tertiary care center between 2020 and 2025. Descriptive statistics and logistic regression models were used to assess associations among demographic characteristics, prior treatment history, and antimicrobial resistance. Of 174 patients (56.1% male, median 14 years), 50.3% were resistant to at least one antimicrobial. Resistance rates included metronidazole (28.3%), clarithromycin (18.5%), rifampin (12.7%), fluoroquinolones (11.6%), amoxicillin (4%), and tetracycline (0.6%). The multidrug resistance rate was 17.3%. Prior H. pylori treatment was the most consistent predictor of antimicrobial resistance on both bivariate and multivariable analyses. Race was independently associated with metronidazole resistance, with Black patients exhibiting the highest rates and significantly greater odds compared to White patients. Hispanic ethnicity was also independently associated with increased odds of metronidazole resistance. Careful consideration of prior treatment history, race, and ethnicity is warranted when managing pediatric H. pylori infection, given their association with increased antimicrobial resistance.