Next-generation sequencing techniques have revolutionized the epidemiology and understanding of Campylobacter spp. infections. In this study, we present the results of a next-generation sequencing (NGS) analysis conducted in 2024 on 2,360 Campylobacter spp. strains isolated in France, including 1,959 Campylobacter jejuni, 358 Campylobacter coli, and 43 Campylobacter fetus strains. We describe the diversity of circulating strains and provide an overview of the main mechanisms of antibiotic resistance. We identified a variety of resistance mechanisms, particularly for resistance to group A penicillins. Notably, we identified a novel promoter upstream of the gene encoding a beta-lactamase. Using source attribution markers for C. jejuni and C. coli, we identified poultry as the main vector for infections by these two species. However, ruminant meat accounts for a significant proportion of C. jejuni infections in France. This study demonstrates how a sequencing strategy can generate large-scale and high-resolution data for understanding Campylobacter spp. infections.

Because few studies have focused on recurrent Campylobacter bacteremia, we investigated two clinical cases of patients with common variable immunodeficiency and repeated Campylobacter bacteremia over a period of 6–10 years. We analyzed and compared genomes from isolates obtained from both patients during follow-up. For patient #1, 18 isolates of Campylobacter coli and 17 isolates of Campylobacter jejuni were obtained from 2014 to 2024. For patient #2, 10 isolates of C. coli were obtained from 2019 to 2024. Next-generation sequencing was used to identify species, characterize antimicrobial resistance, perform multilocus sequence typing, and analyze core-genome single-nucleotide polymorphisms, as well as to uncover potential sources of contamination. For patient #1, all 18 C. coli isolates obtained from 2022 to 2024 were from the same clonal complex and source of contamination (chicken) and exhibited high levels of genomic resemblance based on core-genome single-nucleotide polymorphism analysis. Each C. coli isolate probably originated from the same initial strain. However, two clusters of C. jejuni were identified: one consisting of isolates from 2014 and the other consisting of the remaining isolates from 2022 to 2024. A 16S rRNA mutation in position A1387G was present in four C. coli isolates from 2022 and 2023, and this was associated with gentamicin resistance. One C. coli isolate was also resistant to ertapenem and exhibited an amino acid duplication within the PorA protein sequence. For patient #2, each C. coli isolate was from the same clonal complex, which was of porcine origin. Similar to patient #1, three of the isolates from 2023 had an A1464G 16S rRNA mutation and were gentamicin resistant. Retrospective analyses of antimicrobial use for both patients highlighted an association between antimicrobial selection pressure and the emergence of resistance markers, suggesting in vivo selection.

Human infections with non-Helicobacter pylori Helicobacter species (NHPH) are rare. The diagnosis of such infection relies strongly on histological methods, as these bacteria cannot be easily cultured. We describe microbiological analyses that were performed on three cases of infection reported between 2020 and 2023, for which molecular biology was used to identify the species and facilitate the investigation of markers of resistance to macrolides and fluoroquinolones. 16S rRNA sequencing identified two Helicobacter suis strains and one Helicobacter heilmannii sensu strictostrain. Sequencing of 23S rRNA and quinolone resistance determining region of the gyrA gene, classically described as carrying mutations associated with resistance to macrolide and levofloxacin, respectively, did not reveal any mutations. RIDA®GENE H. pylori, the Allplex™ H. pylori and ClariR Assay and Amplidiag® H. pylori+ClariR cross-react with these NHPH strains. Any case of NHPH infection diagnosed by histology should be confirmed by molecular biology in specialized laboratories to identify the species and investigate the resistome.

Helicobacter pylori (H. pylori) is a frequent infection, with a higher prevalence in developing countries. French Guiana, although French, is a region with a high level of poverty and a high incidence of gastric cancer, for which H. pylori is a known risk factor. However, epidemiological data regarding H. pylori infection in this region remain scarce. The aim of this study was to assess the prevalence of H. pylori infection and resistance to clarithromycin. We retrospectively included all patients who underwent a gastroscopy during which gastric biopsies samples were taken for molecular biology testing, H. pylori PCR. Culture was performed if H. pylori PCR detected resistance to clarithromycin. Sex, age and place of birth were analyzed to describe the population and the factors associated with infection. A total of 443 patients were included. H. pylori PCR was positive in 174 patients (39.3

The species most frequently causing campylobacteriosis are Campylobacter jejuni and Campylobacter coli, followed by Campylobacter fetus, Campylobacter upsaliensis, and Campylobacter lari. Although polymerase chain reaction (PCR) can be used to detect Campylobacter DNA in stool samples, PCR assays are often validated for C. jejuni and C. coli only, and coproculture results can take several days to receive. For laboratories that do not have access to PCR technology, rapid antigen tests can be of the utmost importance for early diagnosis of the disease. We evaluated the performance of the Sofia Campylobacter Fluorescence Immunoassay (SCFIA) for rapid detection of Campylobacter antigens in stool. Methods: In total, 94 frozen and 205 fresh stool specimens were included in retrospective and prospective evaluations, respectively. The linearity of the assay and its limit of detection for different Campylobacter species was evaluated using serial dilutions. Cross reactivity to phylogenetically related species was also investigated. The PCR results from the BD MAX Enteric Panel were considered the gold standard. Results: The sensitivity of the SCFIA was 97.87

Aliarcobacter spp. bacteria are human enteropathogens, as are Campylobacter spp. However, the epidemiology of the former infections is not well described. Here, we present microbiological and clinical data on 1,204 Aliarcobacter spp. infections that occurred in France between 2002 and 2024. Aliarcobacter butzleri was the principal species identified, followed by A. cryaerophilus. Aliarcobacter spp. infections affected patients principally over 60 years of age, mostly men, particularly during autumn. Analysis of 253 clinical information sheets highlighted both diarrhea and abdominal pain that were only rarely associated with fever or blood in the stool. Many isolates of both main species were resistant to group A penicillins and ciprofloxacin.

BACKGROUND:Rising antimicrobial resistance of Helicobacter pylori is a public health challenge. Genomic-based susceptibility testing allows for the identification of resistance-associated mutations, complementing conventional diagnostics and advancing towards pathogen-based personalised therapies. Our study aimed to identify genes and mutations involved in antimicrobial resistance in H pylori and evaluate the extent to which these markers can be used as predictors of phenotypic resistance against clarithromycin and levofloxacin. METHODS:In this retrospective phenotypic and genotypic observational study, we included 1011 H pylori whole-genome sequences and strains of known geographical origin from the H pylori Genome Project (HpGP) collection. We performed phenotypic clarithromycin and levofloxacin susceptibility testing on a subset of 419 HpGP strains using Etest at a centralised laboratory. A genomic analysis was conducted to identify 23S rRNA and gyrA variants and build a curated catalogue of mutations associated with resistance to clarithromycin (ie, 23S rRNA 2142A→G, 2142A→C, and 2143A→G) and levofloxacin (ie, gyrA A88V or A88P, N87K or N87I, and D91G, D91N, or D91Y). Genotype-phenotype concordance was assessed to estimate sensitivity and specificity, and the curated catalogue of resistance-associated mutations was applied to the complete HpGP set. Region-specific prevalence of resistance-associated mutations was calculated for a combined dataset including the HpGP genomes and 768 whole-genome sequences retrieved from the US National Center for Biotechnology Information Sequence Read Archive repository. Associations between resistance genotypes, H pylori subpopulations, and minimum inhibitory concentrations (MICs) were tested. FINDINGS:Clarithromycin-resistant and levofloxacin-resistant HpGP strains were estimated with a sensitivity and specificity of 100%, with all confidence intervals ranging from 96% to 100%. The combined analysis (n=1779) found the highest prevalence of clarithromycin resistance in the western Pacific region (173 [51·2%] of 338 in southeast Asia and 75 [29·8%] of 252 in eastern Asia), north African region (seven [38·9%] of 18), and western Asian region (12 [31·6%] of 38), whereas the highest prevalence of levofloxacin resistance was found in south Asia (14 [51·85%] of 27), Central America (48 [38·7%] of 124), eastern Europe (four [36·4%] of 11), and southern Africa (three [33·3%] of nine). Similarly, 23S rRNA and gyrA genotypes are variable across H pylori subpopulations. MIC values changed depending on the specific mutation in 23S rRNA (mean clarithromycin MIC 24·61 mg/L [95% CI 12·27-36·96] for 2143A→G and 142·25 mg/L [95% CI 77·88-206·61] for 2142A→G) and gyrA (mean levofloxacin MIC 9·66 mg/L [95% CI 6·75-12·56] for mutations on codon 91, and 27·97 mg/L [95% CI 25·82-30·11] for mutations on codon 87). INTERPRETATION:Mutations in specific genes are reliable indicators to clarithromycin and levofloxacin resistance in H pylori, making them useful markers for the development of diagnostic assays and molecular monitoring. Our results suggest that using clarithromycin and levofloxacin empirically, without previous susceptibility testing, is unsuitable in all geographical regions covered by this study. FUNDING:Intramural Research Program of the US National Cancer Institute, the European Research Council, and the Spanish Ministry of Science and Innovation.

Background: Coagulase-negative staphylococci (CONS) are a major cause of late-onset neonatal sepsis, particularly in preterm infants, with high morbidity and mortality. While vancomycin is the first-line treatment for these infections, the optimal administration in neonates remains uncertain. Objective: We aim to compare the outcomes of neonates with CONS bacteremia treated with adjusted continuous infusion (CIV) versus standard intermittent infusion (IIV) of vancomycin. Methods: This retrospective study included 110 neonates, with 29 in the CIV group and 47 in the IIV group after propensity score matching. The primary outcome was treatment failure defined by the persistence of a positive blood culture for the same organism after at least 48 hours of vancomycin treatment. Results: After matching, the CIV group exhibited significantly lower treatment failure rates [5/29 (17%) vs. 26/47 (44%); P = 0.014] and a higher rate of achieving therapeutic vancomycin levels after 24 hours [20/29 (69%) vs. 26/47 (44%); P = 0.002] compared to the IIV group. No significant differences were observed in terms of acute kidney failure between the 2 groups. Conclusion: Adjusted continuous vancomycin infusion in neonates with CONS bacteremia is associated with a lower treatment failure rate without an increase in renal toxicity compared to standard intermittent infusion. However, due to the observational design, larger prospective studies are needed to validate these results.

Macrolides are the first-line compounds used for the treatment of campylobacteriosis. Macrolide resistance remains low in France, with mutations in 23S rDNA being the main associated resistance mechanism. However, two erythromycin methyltransferases have also been identified: erm(B), which is mainly described in animal reservoirs, and erm(N), which is strictly described in humans. In France, between 2018 and 2023, erythromycin-resistant Campylobacter species strains were systematically sequenced and analyzed via an in-house bioinformatics pipeline, leading to the identification of the resistomes, MLST and cgMLST, as well as the characterization of the source of contamination. In this study, the genomes of 280 erythromycin-resistant strains were sequenced over a 6-year period. The identification of erythromycin-associated resistance markers revealed a predominance of 23S rDNA mutations, in 90% of cases, but also erm-type methyltransferases in 10% of cases: 75% for erm(N) and 25% for erm(B). Over this period, an important increase in the rate of erm-positive isolates was observed: 2% in 2018 compared with 13% in 2023, with 10% for erm(N) and 3% for erm(B). erm(N) has been found exclusively within a CRISPR-Cas9 operon, whereas erm(B) has been found within diverse types of resistance genomic islands. Each erm(N)- or erm(B)-positive isolate had at least two other resistance markers (mostly ciprofloxacin, tetracycline, or ampicillin) and often carried aminoglycoside-associated resistance genes. The majority of the erm-positive isolates were obtained from chicken. The increasing rates of erm-positive and multiresistant isolates make the monitoring of erythromycin-resistant Campylobacter strains, specifically within the chicken meat production, a topic of serious importance.

This study assessed the clinical performance of the Biosynex AMPLIQUICK Fecal Bacteriology kit for detecting enteropathogenic bacteria in cases of acute community-acquired diarrhea. In total, 194 retrospectively collected and 207 prospectively collected stool samples were analyzed. In cases of discordant results between the AMPLIQUICK Fecal Bacteriology kit and initial status of the 401 stools, samples were reanalyzed using the Seegene Gastrointestinal Panel 1 and 2 kits or targeted PCR assays. Among the 401 samples, 190 were expected to be positive for Campylobacter spp. (C. jejuni or C. coli), 48 for Salmonella spp., 39 for Shigella spp./enteroinvasive Escherichia coli (EIEC), 21 for Yersinia enterocolitica, and 30 for enterohemorrhagic E. coli (EHEC). Additionally, 64 samples were expected to be negative. Nine other samples tested positive for either other enteropathogens (Aeromonas spp., Plesiomonas shigelloides, Vibrio spp., or Clostridioides difficile) or co-infections with two pathogens. Only three samples (four discrepancies) yielded discordant results with the AMPLIQUICK Fecal Bacteriology kit: one false positive for enterotoxigenic E. coli (ETEC), one false negative for EHEC, and one sample that was both falsely positive for Salmonella spp. and falsely negative for EHEC. The analytical performance was calculated using a composite reference standard (CRS) in the absence of a perfect gold standard. Due to the low number or absence of positive cases, the performance of the Biosynex AMPLIQUICK Fecal Bacteriology kit could not be determined for Vibrio spp., Yersinia pseudotuberculosis, hypervirulent C. difficile strains, Cholera toxin, ETEC, 0157 EHEC and P. shigelloides. Using this CRS, positive, negative and overall agreement rates ranged from 98.24 to 100% for all the other pathogens. In conclusion, the Biosynex AMPLIQUICK Fecal Bacteriology kit enables comprehensive screening for key bacterial pathogens associated with gastrointestinal infections in a single PCR assay. With excellent clinical performance, it represents a reliable tool for the rapid and accurate diagnosis of bacterial gastroenteritis in routine practice.

In 2023, Helicobacter zhangjianzhongii was proposed as a new species in the Helicobacter genus. We here describe two human cases of H. zhangjianzhongii bacteremia. Four clinical strains from the Helicobacter genus isolated from blood culture between 2017 and 2023 were studied. They were initially identified as H. canis by MALDI-TOF and 16S rDNA sequencing. The strains were biochemically characterized and tested at different temperatures and atmospheres. Two databases were used to characterize the isolates: the Bruker® MBT compass Version 4.1.1 database and a in-house spectrum-enriched database. After bacterial DNA extraction the genomes were sequenced on NovaSeq 6000 (Illumina) and analyzed using an in-house pipeline. Case 1 involved a 58-year-old woman who was hospitalized in a thoracic oncology unit because her general condition deteriorated in a setting of small-cell carcinoma. She presented with abdominal pain associated with significant hepatomegaly. Case 2 involved a 78-year-old woman on rituximab who was hospitalized to treat chest pain, anemia, and inflammatory syndrome. Both strains exhibited very similar microbiological and genomic characteristics, thus growth in a microaerobic atmosphere at 37°C and 42°C, oxidase-positivity, and urease- and catalase-negativity. Both were formally identified by whole-genome sequencing as H. zhangjianzhongii (ANI > 99

The diagnosis of Helicobacter pylori infection from gastric biopsies requires polymerase chain reaction or culture. However, culture is often unsuccessful due to the bacterial fragility and complex growth requirements. Next-generation sequencing (NGS), performed on primary clinical samples, offers a promising alternative for analysis of the bacterial resistome. In this study, we describe the adaptation of a target-enrichment library preparation and NGS workflow for use on formalin-fixed, paraffin-embedded (FFPE) gastric biopsies to investigate both the H. pylori resistome and virulome. In total, 30 FFPE gastric biopsy samples were analyzed, all derived from patients infected with H. pylori, the majority of whom presented with gastritis or epigastric pain. The Agilent SureSelect XT protocol was modified for implementation on the Magnis automated system, and sequencing was performed using the iSeq 100 platform. RNA probes targeting key genes associated with virulence (e.g., cagA and vacA), antibiotic resistance (e.g., 23S rRNA, 16S rRNA, gyrA, and rpoB), and multilocus sequence typing (MLST) were employed. The resulting sequence data were compared to those obtained from cultured H. pylori strains isolated from the same patients. Mutations in 23S rRNA linked to macrolide resistance, those in the quinolone resistance-determining region of gyrA associated with levofloxacin resistance, and those conferring rifamycin resistance were accurately detected. The MLST profiles generated through this method were consistent with those obtained via Sanger sequencing. Furthermore, the cagA gene, including EPIYA motifs, and vacA genotypes were reliably identified. This target-enrichment technique provides accurate access to the H. pylori resistome and virulome directly from FFPE biopsy specimens, representing a significant technological advancement.

The identification of Helicobacter pylori infection from gastric biopsy samples requires PCR or bacterial cultures. However, it is difficult to culture H. pylori because it is a fragile bacterium. Next-generation sequencing (NGS) allows direct assessment of the resistome and virulome. Here we describe a new NGS method for studying the resistome and virulome of H. pylori directly from gastric biopsies, based on enrichment analyses and targeted sequencing of H. pylori DNA. In all, 19 DNA samples from human gastric biopsies that tested positive for H. pylori were analyzed. The Agilent SureSelectXT target-enrichment protocol was used with a custom bait library prior to sequencing using the Agilent MagnisDx NGS Library Prep System. NGS sequencing was performed on the Illumina iSeq 100 sequencer using RNA probes for virulence, resistance, and molecular typing genes. The method yielded significant results with a limit of detection of around 1.8e5 CFU per mL H. pylori. Mutations in the 23S rDNA sequence associated with macrolide resistance and in the quinolone resistance-determining region of gyrase A associated with levofloxacin resistance were correctly identified. The results of MLST phylogeny analyses performed after target-enrichment were consistent with those obtained via conventional Sanger sequencing. Among the cagA-positive isolates, the gene was detected correctly, and the vacA genotype was determined. In conclusion, our enrichment method enables rapid assessment of the resistome and virulome of H. pylori directly from fresh gastric biopsies.IMPORTANCEHelicobacter pylori, a bacterium that infects at least 50% of the world population, is often treated by probabilistic antimicrobial therapies due to the lack of antimicrobial resistance data provided by clinical laboratories to clinicians. However, targeted antimicrobial therapies are increasingly recommended to achieve efficient eradication with a limited impact on the gut microbiota and with fewer adverse events for the patient. Recent advancements in next-generation sequencing strategies have opened new opportunities in the diagnosis of H. pylori infection. The significance of our research is the development of a novel next-generation sequencing strategy based on target-enrichment. This approach enables the identification of the resistome and the virulome of H. pylori directly from gastric biopsies, providing clinicians with a broad overview of therapeutic options.

This study describes the isolation of Helicobacter pylori from a blood sample of an 88-year-old patient with no history or clinical signs suggestive of this infection. We summarize the microbiological characterization of the case, and the subsequent investigation using advanced next-generation sequencing methods, including a target enrichment technique adapted for paraffin-embedded gastric biopsy analysis.

Hypogammaglobulinemia (HG) predisposes patients to gastrointestinal Campylobacter infections. This prospective study determined the prevalence of Campylobacter in stool samples from patients with immunoglobulin (Ig)-substituted HG at Bordeaux University Hospital. 73 patients (42 women, median age: 61) receiving Ig substitution therapy were enrolled from July 2022 to July 2024. Stool samples were analysed with culture, PCR, faecal calprotectin levels, and immune profiles were also assessed. A second stool sample was collected from 38 patients after 6–12 months, totalling 111 samples. 53 patients had primary HG (32 common variable immunodeficiency, 7 IgG subclass deficiencies, 4 Bruton’s agammaglobulinemias) and 20 had secondary HG (7 drug-induced, 8 lymphoid hemopathy-related, 5 mixed). Campylobacter were detected in 11 patients (15.1

Introduction L’hypogammaglobulinémie (HG) peut être primitive ou secondaire. Elle expose les patients à des complications infectieuses notamment sino-pulmonaires à germes encapsulés, mais aussi à des infections digestives bactériennes, tout particulièrement à Campylobacter. L’objectif de cette étude était de déterminer la prévalence du portage digestif de Campylobacter chez les patients présentant une HG substituée en immunoglobulines polyvalentes (Ig). Patients et méthodes Nous avons mené une étude prospective unicentrique au CHU de Bordeaux sur une cohorte de patients pris en charge pour une HG primitive ou secondaire substituée. Les patients éligibles étaient inclus consécutivement. L’étude consistait en un recueil de selle pour recherche de Campylobacter par culture et PCR, un bilan biologique comprenant notamment un dosage de la calprotectine fécale et un bilan immunologique cellulaire et humoral. Un deuxième prélèvement était proposé aux patients 6 à 12 mois plus tard. Résultats Au total, 74 patients ont été inclus dans notre étude (femmes n=43, âge médian 61ans [48-71]), sur une période de 2ans (de juillet 2022 à juillet 2024), parmi lesquels 45 patients ont pu avoir un 2e prélèvement de selles, avec un total de 119 prélèvements de selles réalisés. 54 patients avaient une HG primitive (dont 32 DICV, 8 déficits en sous-classes, 4 agammaglobulinémies de Bruton), et 20 avaient une HG secondaire (7 médicamenteuses, 8 liées à une hémopathie lymphoïde, 5 mixtes). Les patients étaient substitués en médiane depuis 9ans. Le taux résiduel moyen d’immunoglobulines était de 9,97±5,98g/L et le taux d’infection de nos patients était bas avec 8 % des patients ayant eu recours au moins trois fois aux antibiotiques dans l’année précédant l’inclusion.11 patients (15 %) ont eu un prélèvement positif à Campylobacter, dont 1 deux fois. Sur les 7 cultures positives parmi les 11, les bactéries identifiées étaient : Campylobacter jejuni (n=4), Campylobacter coli (n=2) et Aliarcobacter butzelri (n=1). Les données de PCR et de culture témoignaient d’un inoculum important.Parmi les 11 patients positifs, 82 % avaient une HG primitive (6 DICV et 3 Bruton). Parmi les 12 prélèvements positifs, 42 % des patients avaient de la diarrhée au moment du prélèvement (versus 15 % des patients avec prélèvements négatif), et le taux médian de calprotectine fécale était respectivement de 255μg/g (149–678), et 52μg/G (10–206).Le taux résiduel médian d’immunoglobulines au moment du prélèvement était similaire dans les deux groupes (8,8g/L [7,5–10,8] parmi les patients avec prélèvements positifs versus 8,3g/L [7–10,7] en cas de prélèvements négatifs). Les taux moyens d’IgA et d’IgM semblaient plus bas au moment du prélèvement chez les patients avec prélèvement positif mais cette différence n’était pas significative (respectivement 0,5±0,9g/L vs 0,7±0,9g/L et 0,5±0,9g/L vs 1,2±5,3g/L). De même le ratio moyen CD4/CD8 tendait à être plus faible en cas de prélèvement positif (1,71±0,85 vs 2,13±1,21). Conclusion Notre étude identifie une prévalence non négligeable de Campylobacter dans les selles des patients hypo-gammaglobulinémiques malgré une supplémentation en Ig satisfaisante. La fréquence des symptômes digestifs associée à un taux de calprotectine fécale élevée chez les patients positifs pour le Campylobacter laisse supposer une infection à Campylobacter plutôt qu’un portage asymptomatique. Il convient donc chez les patients hypo-gammaglobulinémiques présentant des symptômes digestifs de dépister scrupuleusement les infections à Campylobacter.

Background: Helicobacter pylori infection-associated gastric adenocarcinoma is influenced by various factors, including the digestive microbiota. Lactic acid bacteria role in digestive carcinogenesis has been discussed, and some Lactobacillaceae family species have been shown to act against H. pylori-induced inflammation and colonization. However, their effects on H. pylori-related carcinogenesis have not yet been studied. Lactobacillaceae family effects on the epithelial-to-mesenchymal transition (EMT), emergence of cells with cancer stem cell (CSC) properties and the pro-inflammatory response of gastric epithelial cells to H. pylori infection were investigated. Materials and Methods: A co-culture model of AGS gastric epithelial cells infected with a carcinogenic strain of H. pylori associated with 18 different probiotic strains candidates were used. Different EMT indicators and CSC properties were studied, including quantification of the mesenchymal phenotype, tumorsphere formation, EMT marker expression, and tight junction evaluation with immunofluorescence microscopy. The effect of the strains on the pro-inflammatory response to H. pylori was also evaluated by quantifying interleukin-8 (IL-8) production using ELISA. Results: Among the strains tested, Lactobacillus gasseri BIO6369 and Lacticaseibacillus rhamnosus BIO5326 induced a 30.6% and 38.4% reduction in the mesenchymal phenotype, respectively, caused a significant decrease in Snail and Zeb1 EMT marker expression and prevented the loss of tight junctions induced by H. pylori infection. A separate co-culture with a Boyden chamber maintained the effects induced by the two strains. H. pylori-induced IL-8 production was also significantly reduced in the presence of L. gasseri BIO6369 and L. rhamnosus BIO5326. Conclusion: Lactobacillus gasseri BIO6369 and L. rhamnosus BIO5326 strains decreased epithelial-to-mesenchymal transition and inflammation induced by H. pylori infection, suggesting that these species may have a protective effect against H. pylori-induced gastric carcinogenesis.