Alarmingly high multidrug resistance among Helicobacter pylori isolates from gastric biopsies in Egypt: phenotypic characterization and clinical correlation.

Helicobacter pylori (H. pylori) infection is a major cause of chronic gastritis, peptic ulcer disease, and gastric cancer, while increasing antimicrobial resistance has become a major challenge to successful eradication. This study investigated the phenotypic antimicrobial susceptibility patterns of H. pylori isolates from Egyptian patients and evaluated their associations with clinical characteristics. Gastric biopsy specimens were collected from 60 patients undergoing upper gastrointestinal endoscopy. H. pylori was isolated by culture under microaerophilic conditions and identified using conventional phenotypic methods. Antimicrobial susceptibility was assessed by the disk diffusion method against commonly prescribed antibiotics. H. pylori was successfully isolated from 20 of 60 patients. Gastritis and gastric ulcer were significantly associated with culture positivity (p = 0.002 and p = 0.035, respectively), whereas no significant associations were observed for other clinical manifestations. All isolates (100%) were multidrug-resistant (MDR), and 90% were resistant to both clarithromycin and amoxicillin. Although higher isolation rates were observed among male patients and those aged ≥ 60 years, neither sex nor age was significantly associated with multidrug resistance (p > 0.05). These findings demonstrate an alarming prevalence of MDR H. pylori isolates in Egypt, emphasizing the need for continuous antimicrobial resistance surveillance and susceptibility-guided eradication strategies to improve treatment outcomes.