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The goal of this analysis was to identify the potential relevance between\n                      <jats:italic>cagA<\/jats:italic>\n                      and\n                      <jats:italic>vacA<\/jats:italic>\n                      genotypes with reported antibiotic resistance observed in clinical\n                      <jats:italic>H. pylori<\/jats:italic>\n                      isolates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This literature search was conducted in databases such as Clarivate analytics, PubMed, Scopus, EMBASE, DOAJ, and Google Scholar by April 2022, regardless of language restrictions and publication date. Quality of the included studies was assessed by the Newcastle\u2013Ottawa scale. Statistical analysis of retrieved studies was fulfilled using Comprehensive Meta-Analysis software version 2.2. Following quality appraisal of eligible studies, potential association between the status of\n                      <jats:italic>cagA<\/jats:italic>\n                      and\n                      <jats:italic>vacA<\/jats:italic>\n                      genes with resistance to clarithromycin, metronidazole, amoxicillin, tetracycline, and levofloxacin was measured using odds ratio with 95% confidence interval. We also used sensitivity analyses and meta-regression to eliminate the source of heterogeneity from the overall estimates. Publication bias was assessed using funnel plot, Egger\u2019s test, Begg\u2019s test with the trim and fill procedure to assess the presence and magnitude of publication bias in the included studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our findings suggested that a significant relationship between\n                      <jats:italic>cagA<\/jats:italic>\n                      status \u200eand increase resistance \u200eto metronidazole (OR: 2.69; 95% CI: 1.24\u20135.83\u200e\u200f\u200e). In subgroup analysis, we \u200efound that in the Western \u200epopulation, infection with\n                      <jats:italic>cagA<\/jats:italic>\n                      -positive strains could be led to increase in \u200ethe resistance to \u200emetronidazole (OR: 1.59; 95% CI: \u200e0.78\u20133.21\u200e\u200f\u200e), \u200eamoxicillin (OR: \u200e19.68\u200e; 95% CI: 2.74\u2013\u200e\u200e141.18), \u200eand \u200elevofloxacin (OR: \u200e11.33; 95% CI: \u200e1.39\u2013\u200e\u200e91.85). After implementation of trim and fill method, the adjusted OR was not significantly differed from original estimates which in turn represented our subgroup analysis was statistically robust. On the other hand,\n                      <jats:italic>vacA<\/jats:italic>\n                      \u200egenotypes usually \u200ereduce the antibiotic resistance of this bacterium, so that\n                      <jats:italic>vacA<\/jats:italic>\n                      s1m1 significantly reduces the \u200eresistance to \u200emetronidazole (OR: 0.41; 95% CI: 0.20\u20130.86\u200e\u200f\u200e). Surprisingly, resistance of\n                      <jats:italic>vacA<\/jats:italic>\n                      s2m2 strains to antibiotics was low, the reason may be due \u200eto the non-inflammatory properties of strains containing\n                      <jats:italic>vacA<\/jats:italic>\n                      s2m2. The meta-regression and sensitivity analyses successfully reduced the effect of heterogeneity from the overall estimates. In addition, although the pooled OR is reduced after trim and fill adjustment but results do not change the conclusion regarding\n                      <jats:italic>vacA<\/jats:italic>\n                      genotypes and antibiotic resistance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      According to our findings, it was clearly demonstrated that\n                      <jats:italic>cagA<\/jats:italic>\n                      -positive strains are resistance to metronidazole, especially in Western countries. In Western countries,\n                      <jats:italic>vacA<\/jats:italic>\n                      s1m1 increases resistance to amoxicillin and levofloxacin. Based on the present findings, the\n                      <jats:italic>vacA<\/jats:italic>\n                      s1m1 genotype significantly increases resistance to metronidazole, while the\n                      <jats:italic>vacA<\/jats:italic>\n                      s1m2 decreases resistance to clarithromycin and metronidazole. Resistance to antibiotics in less virulent (\n                      <jats:italic>vacA<\/jats:italic>\n                      s2m2) strains is statistically significant lower than others.\u00a0\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-022-07546-5","type":"journal-article","created":{"date-parts":[[2022,6,25]],"date-time":"2022-06-25T09:04:20Z","timestamp":1656147860000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Clinical relevance of the cagA and vacA s1m1 status and antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"22","author":[{"given":"Mohsen","family":"Karbalaei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Talebi Bezmin Abadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoud","family":"Keikha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,6,25]]},"reference":[{"issue":"2","key":"7546_CR1","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1053\/j.gastro.2017.04.022","volume":"153","author":"JK Hooi","year":"2017","unstructured":"Hooi JK, Lai WY, Ng WK, Suen MM, Underwood FE, Tanyingoh D, Malfertheiner P, Graham DY, Wong VW, Wu JC. 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