Helicobacter pylori in water, vegetables and foods of animal origin: A systematic review and meta-analysis on the prevalence, antibiotic resistance and genotype status in Iran

This study was conducted to investigate the prevalence, antibiotic resistance and genotype status of Helicobacter pylori strains in water, vegetables and foods of animal origin in Iran. National and international databases were searched using MeSH-extracted keywords in English and Persian languages to find relevant publications by up to November 01, 2019. Among articles that were identified from national and international databases on antibiotic resistance as well as genotype and the prevalence of Helicobacter pylori, 20 articles were included in the meta analysis according to the predefined inclusion and exclusion criteria. The prevalence of Helicobacter pylori strains isolated from various foods, vegetables and water in Iran was 11.4% (8.5-15.2). VacA s1a (69.3%) had the highest, while VacA s1c (11.1%) showed the lowest prevalence of Helicobacter pylori genes. Additionally, in the current study, Helicobacter pylori resistance rates were as follows: 66.3% to metronidazole, 42.4% to clarithromycin, 72% to amoxicillin, 68% to tetracycline, 33.4% to levofloxacin, 19.8% to rifampin, 17.2% to furazolidone, 22.6% to streptomycin, 61.1% to erythromycin, 84.8% to ampicillin, 49% to trimethoprim, 20.2% to cefsulodin and 13.4% to spiramycin. Our findings revealed that the prevalence and antibiotic resistance rates of Helicobacter pylori have reached alarming levels in water, vegetables and foods of animal origin in Iran. These issues can greatly affect the risk of bacterial transmission and efficacy of antibiotic treatment in human infections.