Characterization of antibiotic resistance and biofilm formation in clinical Helicobacter pylori isolates from Ningxia, China

The global issue of Helicobacter pylori (H. pylori) resistance has become increasingly severe, with biofilm formation identified as a significant contributor to drug resistance and subsequent treatment failures. This study investigated 78 strains of H. pylori in the Ningxia province of China over a two-year period, focusing on infection rates, drug resistance, biofilm formation, and genetic characteristics. The results indicated that 56 strains (71.8%) exhibited resistance, and 48 patients (61.5%) were diagnosed with atrophic gastritis. Notably, metronidazole resistance was the most prevalent, accounting for 65.3%, and multidrug-resistant strains were also identified. Further investigation revealed that high biofilm-forming H. pylori demonstrated a higher proportion of resistance to metronidazole, clarithromycin, and levofloxacin compared to low biofilm-forming H. pylori. Next-generation sequencing data demonstrated low homology among the strains, suggesting that this genetic diversity may drive the strains to evolve along distinct pathways, ultimately resulting in the emergence of more complex drug-resistant isolates within the studied population, despite the limited data size.