ISSN: 1859 - 2872
Genetic diversity in the quinolone resistance-determining region of gyrA in H. pylori
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Objective: Levofloxacin (LEV) is the common quinolone antibiotic and a practical option in H. pylori eradication regimens. The LEV resistance can be acquired through variant sequences of a gyrA. This study investigated the correlation between gyrA genetic diversity and LEV resistance in H. pylori. Subject and method: We conducted a cross-sectional study that included 99 H. pylori strains isolated from patients with gastritis, peptic ulcer disease, and gastric cancer at the 108 Military Central Hospital from 2019 to 2022. The minimum inhibitory concentration (MIC) of each strain against levofloxacin was determined using the E-test method. Sanger sequencing was used for variant identification and analysis of gyrA. Mutations were found among both susceptible and non-susceptible strains. Result: Resistance to LEV was observed in 33.3% of the H. pylori isolates, significantly higher in female. Most LEV-resistant strains carry genetic mutations in the quinolone resistance-determining region (QRDR) of gyrA among LEV-resistant strains was remarkably higher than in LEV-sensitive strains. The presence of D91G/Y/N and N87K/I point mutations among non-susceptible was remarkably higher than among susceptible strains. A higher prevalence of mutations outside QRDR (R130K) in resistant strains was also noted. Multiple mutations in the gyrA are only found among resistant strains. All mutant strains exhibited a higher MIC for LEV than wild strains, but statistical significance was only found in strains with D91G/Y/N mutation. Conclusion: Mutation located in the QRDR region (D91G/Y/N, N87K/I) and outside that region (R130K) might result in the LEV-resistance of H. pylori.
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