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. 2025 Feb;44(2):405-416.
doi: 10.1007/s10096-024-05018-z. Epub 2024 Dec 17.

Prevalence and antimicrobial resistance of highly virulent cagA-positive Helicobacter pylori strains in Southern Poland

Karolina Klesiewicz  1 , Monika Orczykowska-Kotyna  2 , Iwona Skiba-Kurek  3 , Joanna Empel  2 , Katarzyna Kania  3   4 , Elżbieta Karczewska  3
Affiliations

Prevalence and antimicrobial resistance of highly virulent cagA-positive Helicobacter pylori strains in Southern Poland

Karolina Klesiewicz et al. Eur J Clin Microbiol Infect Dis. 2025 Feb.

Abstract

Purpose: Assessment of Helicobacter pylori (H. pylori) prevalence in Southern Poland, focusing on highly virulent cagA-positive strains associated with gastric cancer risk, along with analysis of antimicrobial resistance and its molecular mechanisms.

Methods: A total of 130 dyspeptic patients, who underwent endoscopy, were enrolled in the study. Presence of H. pylori in gastric mucosa biopsy specimens was confirmed by rapid urease tests, histological examination, culture, and molecular assays. Antimicrobial susceptibility was tested using the E-test, while the cagA gene (virulence marker) was identified by PCR. The GenoType HelicoDR detected mutations for resistance to clarithromycin (23 S rRNA) and levofloxacin (gyrA). Resistance to rifampicin and levofloxacin was investigated by sequencing the rpoB and gyrA genes.

Results: H. pylori prevalence in Southern Poland was 30.8%, with 60% of infections involving cagA-positive strains. Susceptibility testing revealed resistance rates of 22.9% for metronidazole, 14.3% for clarithromycin, 11.4% for levofloxacin and 25.7% for rifampicin. Among the 24 cagA-positive strains, 45.8% were resistant to at least one antibiotic. Clarithromycin resistance was caused by A2143G mutation. The gyrA gene sequence showed the N87K mutation linked to fluoroquinolone resistance. No mutations were found in the rpoB gene.

Conclusion: Infections with multidrug-resistant CagA-positive strains require recommended treatment strategies due to the high risk of progression of infection to gastric cancer.

Keywords: Helicobacter pylori; Antimicrobial resistance; CagA protein; Gastric cancer; Peptic ulcer disease; Sequencing; Treatment; Virulence factors.

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Conflict of interest statement

Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Bioethical Commission of the Jagiellonian University (Krakow, Poland; No. 122.6120.273.2015). Before participating in the study, each patient signed an informed consent form for participation in the research project. Competing interests: The authors declare no competing interests.

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