title: Clinical relevance of culture: why, how, and when.
abstract: BACKGROUND
  Culture for Helicobacter pylori is undertaken for research and industrial and diagnostic purposes, including antibiotic sensitivity testing of the isolate. The objective of this review is to evaluate the clinical relevance of culture for H. pylori.
  
  
  METHODS
  The clinical relevance of culture for H. pylori is explored by a critical review of the literature.
  
  
  RESULTS
  Primary isolation of the organism from specimens has direct clinical relevance in terms both of detecting colonization and of determining the antibiotic sensitivity of the isolate, which information is used for patient management and for local, national, or international prevalence rates and trends. It is suggested that when endoscopy is undertaken as part of a management algorithm, a biopsy should always be obtained for culture and sensitivity testing. H. pylori can be cultured from specimens on a variety of selective media, which are selected on the basis of the growth requirement of the organism. Standardization of culture media, culturing methods, and interpretive values for sensitivity testing of isolated strains is lacking. Culture of H. pylori on an industrial scale requires fermenter technology and media that maximize the production of bacterial products that can be easily purified and used as diagnostic or therapeutic agents.
  
  
  CONCLUSIONS
  Culture of laboratory strains of H. pylori for investigation of the organism's metabolism and virulence factors has only indirect clinical relevance but has led to the identification of targets for therapeutic intervention.
authors.affiliation: Department of Bacteriology, University College London Medical School, UK.
authors.forename: J
authors.initials: J
authors.lastname: Holton
mesh_terms: D001431:Bacteriological Techniques; D016481:Helicobacter Infections / Q000382:microbiology*; D016480:Helicobacter pylori / Q000166:cytology / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans