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Review
. 2024 Feb 14;62(2):e0073223.
doi: 10.1128/jcm.00732-23. Epub 2024 Jan 9.

Testing for Helicobacter pylori in an era of antimicrobial resistance

Audrey N Schuetz #  1 , Elitza S Theel #  1 , Nicolynn C Cole  1 , Tanner E Rothstein  1 , Garrett G Gordy  1 , Robin Patel  1   2
Affiliations
Review

Testing for Helicobacter pylori in an era of antimicrobial resistance

Audrey N Schuetz et al. J Clin Microbiol. .

Abstract

Antimicrobial resistance in Helicobacter pylori has reached alarming levels and is compromising traditional empiric treatment of H. pylori. Antimicrobial susceptibility testing is routinely performed for infectious diseases when there is a risk of resistance and is now recommended to guide therapy for H. pylori. This mini-review overviews the current diagnostics for H. pylori with a focus on tests that enable susceptibility-guided treatment, including molecular tests performed directly on stool and endoscopically collected specimens.

Keywords: Helicobacter pylori; stomach biopsy; stool PCR; urea breath test.

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Conflict of interest statement

All authors are employed by Mayo Clinic. R.P. reports grants from ContraFect, TenNor Therapeutics Limited, and BIOFIRE and is a consultant to PhAST, Day Zero Diagnostics, and HealthTrackRx; monies are paid to Mayo Clinic. Mayo Clinic and R.P. have a relationship with Pathogenomix. R.P. has research supported by Adaptive Phage Therapeutics. Mayo Clinic has a royalty-bearing know-how agreement and equity in Adaptive Phage Therapeutics. R.P. is a consultant to Abbott Laboratories and CARB-X and has a patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, and a patent on an anti-biofilm substance issued. R.P. receives honoraria from the NBME, Up-to-Date and the Infectious Diseases Board Review Course. A.S. is a consultant to Merck & Co. The other authors have no relevant disclosures.

Figures

Fig 1
Fig 1
Diagnostic algorithm for Helicobacter pylori.
Fig 2
Fig 2
Curved Helicobacter pylori organisms within the crypt lumen of a gastric biopsy specimen. Hematoxylin & eosin stain, 1000× magnification (A). H. pylori immunohistochemical stain, 400× magnification (B). Small, gray, translucent H. pylori colonies on Brucella medium agar with defibrinated sheep blood, vitamin K1, and various antimicrobials to inhibit overgrowth (C). Gram stain of H. pylori colonies from growth on a plate, 1,000× magnification (D). Organisms are rod like and slightly curved. The smaller amorphous pink structures in the background are agar material. Steers replicator inoculation of agar dilution plates for H. pylori antimicrobial susceptibility testing (E); plate after incubation (F). Each position on the susceptibility plate contains a quality control or patient isolate. An ink spot is included to guide plate orientation. E, F are representative of testing done at the authors’ institution and are shown as an example; details as to how agar dilution is performed may vary from institution to institution. (All panels used with permission from Mayo Foundation for Medical Education and Research, all rights reserved.)
See this image and copyright information in PMC

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