{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T11:28:02Z","timestamp":1784460482536,"version":"3.55.0"},"reference-count":22,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>The diagnosis and treatment of Helicobacter pylori infection in children represent a major public health problem worldwide, and although prevalence in developed countries has declined, concern about antibiotic resistance continues to grow. This retrospective study aimed to analyze H. pylori infections in children under 15 years of age in Gipuzkoa (Basque Country, Spain) over a 25-year period and to describe patterns of primary and secondary antimicrobial resistance. All diagnostic tests received at a tertiary referral hospital between 2000 and 2024 were reviewed: urea breath test, gastric biopsy culture, string test, and stool antigen detection. Antimicrobial susceptibility testing was performed using the E-test gradient diffusion method. Out of 2855 children investigated, 26.9 were infected with H. pylori. Eradication control was performed in 62.5% (n = 480) of cases. Antimicrobial susceptibility testing was achieved in 96.5% out of the 400 isolates studied. All isolates were sensitive to amoxicillin and tetracyclines. Primary resistance to clarithromycin, metronidazole, and levofloxacin was 28.9%, 19.4%, and 8.9%, respectively, and secondary resistance was 38.7%, 29.7%, and 5.9%, respectively. H.pylori infection remains a challenge in pediatric patients, and the high resistance observed to clarithromycin and metronidazole makes it necessary to monitor the susceptibility of H.pylori and confirms the need for targeted treatment.<\/jats:p>","DOI":"10.3390\/microorganisms14020389","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T10:05:47Z","timestamp":1770372347000},"page":"389","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Helicobacter\u00a0pylori Infection and Antimicrobial Resistance Surveillance over 25 Years in Children in Gipuzkoa, Northern Spain"],"prefix":"10.3390","volume":"14","author":[{"given":"Itsaso","family":"Jimenez","sequence":"first","affiliation":[{"name":"Microbiology Department, Donostia University Hospital, Osakidetza Basque Health Service, Paseo Dr Beguiristain s\/n, 20014 San Sebasti\u00e1n, Gipuzkoa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0810-6435","authenticated-orcid":false,"given":"I\u00f1igo","family":"Ansa","sequence":"additional","affiliation":[{"name":"Microbiology Department, Donostia University Hospital, Osakidetza Basque Health Service, Paseo Dr Beguiristain s\/n, 20014 San Sebasti\u00e1n, Gipuzkoa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6199-0138","authenticated-orcid":false,"given":"Pedro","family":"Vallejo","sequence":"additional","affiliation":[{"name":"Microbiology Department, Biogipuzkoa Health Research Institute, Donostia University Hospital, Osakidetza Basque Health Service, 20014 San Sebasti\u00e1n, Gipuzkoa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6554-4912","authenticated-orcid":false,"given":"Milagrosa","family":"Montes","sequence":"additional","affiliation":[{"name":"Microbiology Department, Biogipuzkoa Health Research Institute, Donostia University Hospital, Osakidetza Basque Health Service, 20014 San Sebasti\u00e1n, Gipuzkoa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.5005\/jp-journals-10018-1208","article-title":"Epidemiology, Diagnosis, and Risk Factors of Helicobacter pylori Infection in Children","volume":"7","author":"Ozbey","year":"2017","journal-title":"Euroasian J. Hepato-Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1053\/j.gastro.2017.04.022","article-title":"Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis","volume":"153","author":"Hooi","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.jiac.2019.02.016","article-title":"Rapidly decreasing prevalence of Helicobacter pylori among Japanese children and adolescents","volume":"25","author":"Miyamoto","year":"2019","journal-title":"J. Infect. Chemother."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1002\/jpn3.12314","article-title":"Updated joint ESPGHAN\/NASPGHAN guidelines for management of Helicobacter pylori infection in children and adolescents (2023)","volume":"79","author":"Homan","year":"2024","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1097\/MPG.0000000000001594","article-title":"Joint ESPGHAN\/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)","volume":"64","author":"Jones","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_6","first-page":"65","article-title":"How and when investigating and treating Helicobacter pylori infection in children","volume":"89","author":"Manfredi","year":"2018","journal-title":"Acta Biomed."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1002\/jpn3.70123","article-title":"Evolution of antibiotic resistance pattern of Helicobacter pylori in Spanish children: A 10-year multicenter study","volume":"81","author":"Botija","year":"2025","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Salahi-Niri, A., Nabavi-Rad, A., Monaghan, T.M., Rokkas, T., Doulberis, M., Sadeghi, A., Zali, M.R., Yamaoka, Y., Tacconelli, E., and Yadegar, A. (2024). Global prevalence of Helicobacter pylori antibiotic resistance among children in the World Health Organization regions between 2000 and 2023: A systematic review and meta-analysis. BMC Med., 22.","DOI":"10.1186\/s12916-024-03816-y"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1053\/j.gastro.2018.07.007","article-title":"Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions","volume":"155","author":"Savoldi","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/S0140-6736(95)90524-3","article-title":"Non-endoscopic method to obtain Helicobacter pylori for culture","volume":"345","author":"Montes","year":"1995","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.1111\/j.1572-0241.1999.3075_e.x","article-title":"How long for the routine Helicobacter pylori antimicrobial susceptibility testing? The usefulness of the string test to obtain helicobacter for culture","volume":"94","author":"Montes","year":"1999","journal-title":"Am. J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jgar.2023.07.002","article-title":"Surveillance of Helicobacter pylori resistance over 22 Years (2000\u20132021) in Northern Spain","volume":"34","author":"Tamayo","year":"2023","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_13","unstructured":"(1999). Performance Standards for Antimicrobial Susceptibility Testing; Ninth Informational Supplement (Standard No. NCCLS Document M100-S9)."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jgar.2016.12.019","article-title":"Clarithromycin resistance in Helicobacter pylori and its molecular determinants in Northern Spain, 2013\u20132015","volume":"9","author":"Tamayo","year":"2017","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"267","DOI":"10.5223\/pghn.2024.27.5.267","article-title":"Clinical Dilemmas for the Diagnosis and Treatment of Helicobacter pylori Infection in Children: From Guideline to Practice","volume":"27","author":"Levy","year":"2024","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"M\u0103rginean, C.O., Meli\u021b, L.E., and S\u0103s\u0103ran, M.O. (2022). Traditional and Modern Diagnostic Approaches in Diagnosing Pediatric Helicobacter pylori Infection. Children, 9.","DOI":"10.3390\/children9070994"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e71238","DOI":"10.1002\/hsr2.71238","article-title":"Global Profile of Drug Resistance Related to Helicobacter pylori Infection in Children: A Systematic Review and Meta-Analysis","volume":"8","author":"Menbari","year":"2025","journal-title":"Health Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Le, L.T.T., Nguyen, T.A., Nguyen, N.A., Nguyen, Y.T.H., Nguyen, H.T.B., Nguyen, L.T., Vi, M.T., and Nguyen, T. (2022). Antibiotic Resistance of Helicobacter pylori in Children with Gastritis and Peptic Ulcers in Mekong Delta, Vietnam. Healthcare, 10.","DOI":"10.3390\/healthcare10061121"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e13006","DOI":"10.1111\/hel.13006","article-title":"Antibiotic resistance, heteroresistance, and eradication success of Helicobacter pylori infection in children","volume":"28","author":"Kotilea","year":"2023","journal-title":"Helicobacter"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1136\/gutjnl-2021-324032","article-title":"Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community","volume":"70","author":"Megraud","year":"2021","journal-title":"Gut"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s12098-025-05635-2","article-title":"Helicobacter pylori in Turkish Children with Dyspepsia: Diagnosis, Prevalence, Genotyping and Antibiotic Resistance","volume":"93","author":"Altay","year":"2025","journal-title":"Indian J. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1111\/apt.14319","article-title":"Systematic review with meta-analysis: The global recurrence rate of Helicobacter pylori","volume":"46","author":"Hu","year":"2017","journal-title":"Aliment. Pharmacol. Ther."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/2\/389\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T10:20:12Z","timestamp":1770891612000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/2\/389"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,6]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["microorganisms14020389"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14020389","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,6]]}}}