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Molecular characterisation and mutational analysis of antimicrobial resistance genes in Helicobacter pylori isolates in Erbil, Iraq

Othman KI, Mawlood AH, Balaky STJ, Rahnama M, Ahmed MH, Shabila NP

Mutation research, 2026

203 participants

Abstract

Background: Antibiotic resistance in Helicobacter pylori poses a significant challenge to the effective eradication of infection worldwide. Understanding molecular mechanisms of resistance is essential for guiding treatment strategies. This study aimed to investigate the molecular basis of antimicrobial resistance in Helicobacter pylori isolates and their associated mutation frequencies.

Methods: In this cross-sectional study, gastric biopsy specimens were collected from 203 patients at Rizgary Hospital in Erbil, Kurdistan Region, Iraq, who underwent endoscopy for dyspepsia-related symptoms. Of the 137 positive patients, 91 Helicobacter pylori isolates were confirmed by colony morphology, Gram staining, and biochemical tests; 63 were successfully subcultured for antimicrobial susceptibility testing (culture success rate: 69.2%). Antimicrobial susceptibility testing was performed by the agar dilution method to determine the minimum inhibitory concentrations. The sequences of specific genes were examined and analysed by next-generation sequencing. Multiple sequence comparisons were performed to identify resistance-related genes and mutations, using 26695 (NC_000915.1) as the reference genome.

Results: Only two isolates (3.17%) were susceptible to all antibiotics examined. The frequency of metronidazole resistance was highest (85.71%), followed by levofloxacin (55.55%), clarithromycin (52.38%), amoxicillin (26.98%), tetracycline (6.35%), and rifabutin (4.76%). Mutations in the…

How strong is the evidence?

Evidence Hub reads this as a cross-sectional. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 203 participants or records.

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