{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:14:01Z","timestamp":1783336441789,"version":"3.54.6"},"reference-count":48,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":186,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Microbiology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Antibiotic\u2010resistant\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      pose a significant global health challenge. This Egyptian study is aimed at characterizing resistant\n                      <jats:italic>H. pylori<\/jats:italic>\n                      isolates and investigate the association between\n                      <jats:italic>23S rRNA<\/jats:italic>\n                      ,\n                      <jats:italic>gyrA<\/jats:italic>\n                      , and\n                      <jats:italic>rdxA<\/jats:italic>\n                      mutations and phenotypic profiles.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>\n                      Gastric biopsies collected in the internal medicine endoscopy unit were\n                      <jats:italic>H. pylori<\/jats:italic>\n                      tested by rapid urease, histopathology, and culture confirmed by\n                      <jats:italic>ureC<\/jats:italic>\n                      PCR. Antimicrobial susceptibility to clarithromycin, levofloxacin, and metronidazole was evaluated by disk diffusion and agar dilution methods. Sanger sequencing was employed to detect\n                      <jats:italic>23S rRNA<\/jats:italic>\n                      ,\n                      <jats:italic>gyrA<\/jats:italic>\n                      , and\n                      <jats:italic>rdxA<\/jats:italic>\n                      mutations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 81 cultivable\n                      <jats:italic>H. pylori<\/jats:italic>\n                      isolates, bacillary 37\/81 (45.7%), coccobacillary 30\/81 (37.1%), and coccoid 14\/81 (17.2%) forms were seen. Agar dilution confirmed resistance to metronidazole, clarithromycin, and levofloxacin by 72.8%, 23.5%, and 9.9%, respectively. Dual resistance was confirmed by 22.3% versus 2.5% triple resistance. Sequencing results of eight resistant isolates revealed\n                      <jats:italic>23S rRNA<\/jats:italic>\n                      mutations (A2143G, A2142G; 5\/8), whereas\n                      <jats:italic>gyrA<\/jats:italic>\n                      mutations included D91N (2\/8), D91G, and N87K (1\/8 each). A 200\u2010bp\n                      <jats:italic>rdx<\/jats:italic>\n                      deletion was detected (3\/8) along with D59N (2\/8), R131K, A68N, and truncation mutations (each 1\/8). Coccoid (4\/8) and coccobacillary (2\/8)\n                      <jats:italic>H. pylori<\/jats:italic>\n                      forms mixed with gastric microbiota (6\/8), which also demonstrated dual (4\/8) or triple (2\/8) antibiotic resistance, and showed an association with the A2143G and A2142G mutations plus 200\u2010bp deletion in the\n                      <jats:italic>rdxA<\/jats:italic>\n                      gene.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Integrating molecular genotyping with phenotypic diagnostics may improve\n                      <jats:italic>H. pylori<\/jats:italic>\n                      resistance characterization. Findings from this limited number of sequenced resistant isolates suggest a possible association between\n                      <jats:italic>23S rRNA<\/jats:italic>\n                      ,\n                      <jats:italic>gyrA<\/jats:italic>\n                      , and\n                      <jats:italic>rdxA<\/jats:italic>\n                      mutations and virulent, resistant, coccoid\u2010microbiota mixed strains.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/ijm\/6456370","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T10:14:23Z","timestamp":1783332863000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Phenotypic and Genotypic Characterization of Antimicrobial Resistance in\n                    <i>Helicobacter pylori<\/i>\n                    : Association of\n                    <i>23S rRNA<\/i>\n                    ,\n                    <i>gyrA<\/i>\n                    , and\n                    <i>rdxA<\/i>\n                    Gene Mutations With Resistance Patterns"],"prefix":"10.1155","volume":"2026","author":[{"given":"Amal F.","family":"Makled","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hany A.","family":"Abdelaziz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0731-6772","authenticated-orcid":false,"given":"Dina M.","family":"Allam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona F.","family":"Salama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2901-1734","authenticated-orcid":false,"given":"Nashwa N.","family":"Khamis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmaa S.","family":"Sleem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"e_1_2_15_1_2","first-page":"1","article-title":"Prevalence of Helicobacter pylori in Egypt: An Over Estimation or an Iceberg?","volume":"1","author":"Alboraie M.","year":"2023","journal-title":"Global Gastroenterology"},{"key":"e_1_2_15_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2023.1134254"},{"key":"e_1_2_15_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59010006"},{"key":"e_1_2_15_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2023.12.026"},{"key":"e_1_2_15_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2023.1294379"},{"key":"e_1_2_15_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.24885"},{"key":"e_1_2_15_7_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.07.007"},{"key":"e_1_2_15_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-019-4536-8"},{"key":"e_1_2_15_9_2","doi-asserted-by":"publisher","DOI":"10.4291\/wjgp.v13.i1.34"},{"key":"e_1_2_15_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmni.2019.100622"},{"key":"e_1_2_15_11_2","volume-title":"Bailey & Scott\u2032s Diagnostic Microbiology","author":"Tille M. 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