Recurrence of Helicobacter Pylori after Successful Eradication in Northwestern China: Rates, Risk Factors, and Resistance Profiles of Recurrence Isolates

Min Niu,1 Xiaoming Su,1 Zhen Ma,2 Lulu Li21Gastroenterology Department, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China; 2Gastroenterology Department, The Fifth People’s Hospital of Ningxia Hui Autonomous Region, Shizuishan, Ningxia, People’s Republic of ChinaCorrespondence: Lulu Li, Gastroenterology Department, The Fifth People’s Hospital of Ningxia Hui Autonomous Region, Shizuishan, Ningxia, People’s Republic of China, Email 799090798@qq.comPurpose: This study aimed to investigate the recurrence rate of H. pylori after successful eradication in Ningxia, to identify independent risk factors associated with recurrence, and to characterize the antibiotic resistance profiles of isolates obtained from recurrent patients.Methods: This study is a retrospective cohort study. A total of 891 H. pylori-infected patients who received initial eradication treatment and completed 1-year follow-up from June 2021 to October 2024 were included. Demographic characteristics, lifestyle, family hygiene habits, and antibiotic exposure history were collected through questionnaires. A total of 27 strains successfully isolated and cultured from patients with recurrence were tested for antibiotic susceptibility using the Kirby-Bauer disk diffusion method.Results: The H. pylori recurrence rate was 4.1% (37/891). Multivariate logistic regression identified six independent risk factors: rural residence (OR = 3.52, P = 0.003), smoking (OR = 6.06, P < 0.001), frequent shared tableware (OR = 3.46, P = 0.013), frequent dining out (OR = 7.41, P = 0.008), poor dining-out hygiene (OR = 4.50, P = 0.007), and having an H. pylori-infected household member (OR = 5.68, P < 0.001). Of the 37 patients with recurrence, 27 had successful H. pylori culture and obtained susceptibility results. The resistance rates to metronidazole (MET), clarithromycin (CLA), levofloxacin (LEV), and amoxicillin (AMO) were 96.3%, 77.8%, 62.9%, and 3.7%, respectively; all isolates were susceptible to furazolidone (FUR) and tetracycline (TET). Multidrug-resistance was observed in 51.8%, mainly as MET+CLA+LEV pattern (48.1%).Conclusion: The one-year recurrence rate of H. pylori in Ningxia is 4.1%. Factors significantly associated with an increased risk of recurrence include rural residence, smoking, shared tableware, regular dining out, poor dining-out hygiene, and household infection. Isolates from patients with recurrence exhibited high resistance rates to MET, CLA, and LEV, predominantly in multidrug-resistant patterns, whereas resistance to AMO, FUR, and TET remains low.Keywords: H. pylori, recurrence rate, influencing factors, drug resistance