Antimicrobial Resistance Patterns and Determinants of Helicobacter pylori Culture Success: A Prospective Study

<b>Background/Objectives</b>: <i>Helicobacter pylori</i> infection remains a significant health concern, as increasing antimicrobial resistance compromises the efficacy of eradication. Understanding regional antimicrobial resistance profiles is crucial for optimizing eradication strategies. In this study, we aimed to evaluate the antimicrobial susceptibility patterns and identify the factors influencing <i>H. pylori</i> culture success. <b>Methods</b>: In this prospective study, 697 gastric tissue samples were collected from consecutive patients who underwent upper endoscopy between November 2023 and May 2025. Tissue samples obtained by forceps biopsy or recovered from rapid urease test kits were cultured for <i>H. pylori</i>. Antimicrobial susceptibility testing was performed using the agar dilution method; factors associated with successful culture were analyzed using logistic regression. <b>Results</b>: Among 488 patients with <i>H. pylori</i> infection, culture and antimicrobial susceptibility testing were successful in 387 (79.3%). The overall antimicrobial resistance rates were 17.8%, 27.1%, 29.5%, 0.3%, and 32.8% for amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin, respectively. Notably, 27.6% (107/387) of the isolates were resistant to two or more antibiotics. Using multivariate analysis, the use of fresh biopsy tissue (odds ratio [OR]: 1.646, 95% confidence interval [CI]: 1.046-2.591, <i>p</i> = 0.031), transport interval (OR: 0.911, 95% CI: 0.853-0.973, <i>p</i> = 0.005), and presence of prior eradication therapy (OR: 0.318, 95% CI: 0.156-0.648, <i>p</i> = 0.002) were identified as significant predictors of culture success. <b>Conclusions</b>: The high rate of clarithromycin resistance underscores the need for susceptibility-guided eradication strategies in this region. Optimizing sample handling, particularly by minimizing transport time and using fresh biopsy tissue, may improve culture yields.