Published online Aug 28, 2025. doi: 10.3748/wjg.v31.i32.106424
Revised: May 26, 2025
Accepted: August 1, 2025
Published online: August 28, 2025
Processing time: 118 Days and 16.7 Hours
Helicobacter pylori (H. pylori), a globally prevalent pathogen, is exhibiting increasing rates of antimicrobial resistance. However, clinical implementation of pre-treatment susceptibility testing remains limited due to the organism’s fastidious growth requirements and prolonged culture time.
To propose a novel detection method utilizing antibiotic-supplemented media to inhibit susceptible strains, while resistant isolates were identified through urease-mediated hydrolysis of urea, inducing a phenol red color change for visual confirmation.
Colombia agar was supplemented with urea, phenol red, and nickel chloride, and the final pH was adjusted to 7.35. Antibiotic-selective media were prepared by incorporating amoxicillin (0.5 μg/mL), clarithromycin (2 μg/mL), metronidazole (8 μg/mL), or levofloxacin (2 μg/mL) into separate batches. Gastric antral biopsies were homogenized and inoculated at 1.0 × 105 CFU onto the media, and then incubated under microaerobic conditions at 37 °C for 28-36 hours. Resistance was determined based on a color change from yellow to pink, and the results were validated via broth microdilution according to Clinical and Laboratory Standards Institute guidelines.
After 28-36 hours of incubation, the drug-resistant H. pylori isolates induced a light red color change in the medium. Conversely, susceptible strains (H. pylori 26695 and G27) produced no visible color change. Compared with the conventional 11-day protocol, the novel method significantly reduced detection time. Among 201 clinical isolates, 182 were successfully evaluated using the new method, resulting in a 90.5% detection rate. This was consistent with the 95.5% agreement rate observed when compared with microdilution-based susceptibility testing. The success rate of the novel approach was significantly higher than that of the comparative method (P < 0.01). The accuracy of the new method was comparable to that of the dilution method.
The novel detection method can rapidly detect H. pylori drug resistance within 28-36 hours. With its operational simplicity and high diagnostic performance, it holds strong potential for clinical application in the management of H. pylori antimicrobial resistance.
Core Tip: Helicobacter pylori (H. pylori) drug resistance hinders clinical treatment, with slow, inaccurate detection prolonging therapy and reducing efficacy. This paper presents a novel rapid detection method for H. pylori resistance, identifying it in 28-36 hours - much faster than traditional approaches. It offers high accuracy, reliable resistance assessment, and easy operation, suitable for wide use in clinics and research. This method shows great potential to optimize clinical decisions, improve outcomes, and aid H. pylori infection management.