Clinical significance of antibiotic resistance and cagA and vacA s1m1 status in H. pylori

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Created On: 24/08/2022

A systematic review and meta-analysis was conducted to determine the relationship between cytotoxin-associated gene A (cagA) and vacuolating cytotoxin A (vacA) genotypes and antibiotic resistance in Helicobacter pylori (H. pylori) isolates.

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Key take away

Infection with cagA-positive strains of Helicobacter pylori was related to a raised risk of Metronidazole resistance.

Background

Method

Electronic databases such as Google Scholar, DOAJ, EMBASE, Scopus, PubMed, and Clarivate analytics were searched for relevant literature. To assess quality of included studies, Newcastle-Ottawa scale was utilized. The Comprehensive Meta-Analysis software version 2.2 was used to conduct a statistical analysis of the retrieved papers.

An odds ratio with a 95% confidence interval was used to calculate the possible correlation between the status of the cagA and vacA genes and resistance to Clarithromycin, Levofloxacin, Amoxicillin, Metronidazole, and Tetracycline. As additional measures to remove sources of variability from the total results, sensitivity analyses and meta-regression was also utilized. In order to determine if and how much publication bias existed in the included papers, the trim and fill method was used in conjunction with Begg's test, Egger's test, and funnel plot.

Result

A strong correlation between cagA status and an increase in Metronidazole resistance (Odds ratio [OR]: 2.69) was observed. Exposure to cagA-positive strains might enhance Levofloxacin (OR: 11.33), Amoxicillin (OR: 19.68), and Metronidazole (OR: 1.59) resistance in western population. The adjusted OR did not substantially differ from the original values following the use of the trim and fill procedure, indicating that subgroup assessment was statistically significant. Contrarily, vacA genotypes often lowered this bacterium's antibiotic resistance, with vacA s1m1 considerably reducing Metronidazole resistance (OR: 0.41).

Antibiotic resistance of vacA s2m2 strains was minimal; this result may be related to the non-inflammatory characteristics of these strains containing vacA s2m2. The influence of heterogeneity on the overall estimates was satisfactorily lowered by the sensitivity and meta-regression analyses. Even though the pooled OR is lower following the trim and fill adjustments, the findings addressing the relationship between vacA genotypes and antibiotic resistance remain the same.

Conclusion

Metronidazole resistance exists in isolates that are cagA-positive. Amoxicillin and levofloxacin resistance is heightened by VacA s1m1. While the vacA s1m2 genotype diminishes resistance to Clarithromycin and Metronidazole, the vacA s1m1 genotype dramatically enhances resistance to Metronidazole. There were statistically significantly lower levels of antibiotic resistance than other strains in less virulent (vacA s2m2) strains.