{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T07:12:16Z","timestamp":1765609936128,"version":"3.41.2"},"reference-count":31,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,7,1]],"date-time":"2019-07-01T00:00:00Z","timestamp":1561939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003086","name":"Eusko Jaurlaritza","doi-asserted-by":"publisher","award":["2014111045"],"award-info":[{"award-number":["2014111045"]}],"id":[{"id":"10.13039\/501100003086","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Helicobacter pylori<\/jats:italic> infection is associated with chronic gastritis, ulcers and gastric cancer. Antimicrobial resistance has increased worldwide affecting the efficacy of current treatments. Most guidelines recommend implementation of regional surveillance of primary antibiotic resistance of <jats:italic>H\u00a0pylori<\/jats:italic>. Only a fraction of individuals infected with <jats:italic>H\u00a0pylori<\/jats:italic> develop gastric diseases which are related to virulence factors of the bacteria. The aims of the study were to determine the primary antimicrobial resistance rates of <jats:italic>H\u00a0pylori<\/jats:italic> and to know the virulence factors prevalence of strains circulating in Southern Europe.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Susceptibility testing by Etest to clarithromycin, levofloxacin, metronidazole, amoxicillin and tetracycline was performed in 102 isolates (99 na\u00efve patients). The prevalence of virulence factors (<jats:italic>cagA<\/jats:italic>, <jats:italic>vacA<\/jats:italic>, <jats:italic>oipA<\/jats:italic>, <jats:italic>babA<\/jats:italic> and <jats:italic>dupA<\/jats:italic>) was evaluated in 102 <jats:italic>H\u00a0pylori<\/jats:italic> isolates from patients with mild\u2010disease symptoms and in 22 isolates from patients with severe\u2010disease symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Primary resistance rates were 12.1% to clarithromycin, 13.1% to levofloxacin, 24.2% to metronidazole and 0% to amoxicillin and tetracycline. Combined resistance to clarithromycin and levofloxacin was 3% and to clarithromycin and metronidazole 4%. Prevalence of virulence factors in the mild\u2010 and severe\u2010disease group was 35.3% and 81.8% for <jats:italic>cagA<\/jats:italic>, 20.6% and 54.5% for <jats:italic>cagA<\/jats:italic>\/<jats:italic>vacAs1m1,<\/jats:italic> 94.1% and 95.4% for <jats:italic>babA2,<\/jats:italic> 78.4% and 100% for <jats:italic>oipA<\/jats:italic> and 30.4% and 18.2% for <jats:italic>dupA<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Primary antimicrobial resistance rates were under 15% for clarithromycin and levofloxacin. The prevalence of <jats:italic>H\u00a0pylori<\/jats:italic> carrying the virulent genotype <jats:italic>cagA\/vacAs1m1<\/jats:italic> was higher than 20% in the mild\u2010disease and 54% in the severe\u2010disease symptom group.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.13150","type":"journal-article","created":{"date-parts":[[2019,6,13]],"date-time":"2019-06-13T10:23:54Z","timestamp":1560421434000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["<i>Helicobacter pylori<\/i> pathogenicity and primary antimicrobial resistance in Northern Spain"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2513-1109","authenticated-orcid":false,"given":"Mar\u00eda","family":"Fern\u00e1ndez\u2010Reyes","sequence":"first","affiliation":[{"name":"Microbiology Department Donostia University Hospital\u2010Biodonostia Health Research Institute San Sebasti\u00e1n 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