ArticleFrontiers in cellular and infection microbiology2026
Phenotypic and genotypic analysis of
Article in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The continued rise in antibiotic resistance of Methods: Data from 7227 enrolled patients at Nanjing First Hospital (2018-2024) were retrospectively analyzed. Among these, 5729 patients were culture-positive for Results: Metronidazole showed the highest resistance rate at 84.45% (4838/5729, 95% CI: 83.50-85.37), followed by clarithromycin at 50.01% (2865/5729, 95% CI: 48.71-51.31) and levofloxacin at 38.59% (2211/5729, 95% CI: 37.33-39.87). Resistance rates to amoxicillin at 0.51% (29/5729, 95% CI: 0.34-0.73), furazolidone at 0.19% (11/5729, 95% CI: 0.10-0.34), and tetracycline at 0.07% (4/5729, 95% CI: 0.02-0.18) were very low. Annual trend analysis showed that the metronidazole resistance rate remained above 92% since 2020, reaching 98.68% in 2024. Clarithromycin resistance increased from 35.80% to 60.14% and then declined slightly, while levofloxacin resistance rose from 20.99% to 44.59% before reaching a plateau. Genotypic testing for clarithromycin and levofloxacin showed excellent concordance with phenotypic susceptibility (Kappa values: 0.9046 and 0.9187, respectively; both P<0.001). Resistance mutations were highly concentrated in the Conclusion: Metronidazole, clarithromycin, and levofloxacin are no longer suitable as empirical first-line agents in Nanjing. Amoxicillin, furazolidone, and tetracycline remain reliable options. Genotypic testing for clarithromycin and levofloxacin resistance is highly concordant with phenotypic results and suitable for guiding individualized therapy. CYP2C19 genotyping supports personalized acid suppression strategies. Regimens containing amoxicillin, furazolidone, or tetracycline should be prioritized, with resistance gene testing recommended before using clarithromycin or levofloxacin.
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