Virulence genotypes and antibiotic resistance patterns of Helicobacter pylori: A systematic review
Abstract
Helicobacter pylori is a gastric bacterium with a wide global distribution and is recognized for its high genetic diversity, which influences both its virulence and its response to antibiotics. In recent years, the rise in antimicrobial resistance has compromised the effectiveness of empirical therapeutic regimens, highlighting the need to integrate molecular information into the clinical management of the infection. The objective of this systematic review was to analyze recent scientific evidence on the association between virulence genotypes and antibiotic resistance patterns in H. pylori. Methodology: A comprehensive search was conducted in the PubMed, Scopus, ScienceDirect, and Cochrane databases, including primary studies published between 2021 and 2025. After applying the inclusion and exclusion criteria, 24 studies were selected for qualitative analysis. The results showed a high prevalence of virulence genotypes, particularly cagA-positive and vacA s1/m1, which were frequently associated with greater clinical severity and, in several regional contexts, with resistance to first-line antibiotics. Resistance to clarithromycin and fluoroquinolones was mainly linked to mutations in 23S rRNA and gyrA, respectively, whereas resistance to metronidazole exhibited more heterogeneous genetic mechanisms. Conclusions: These findings support the implementation of molecular diagnostic approaches and personalized therapeutic strategies to optimize H. pylori eradication and contain…
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Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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