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The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) tool was used to assess the certainty of the evidence for the two primary biochemical outcomesserum vitamin B12 concentration increase and homocysteine reductionacross all included studies, and separately for randomised controlled trials (RCTs) and observational studies

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Its pathogenicity is closely linked to specific adhesion-associated genes (e.g., fimA, sfaA, and focA) and aminoglycoside-resistance genes (aph(6)-Id, strAB), which facilitate both mucosal colonization and evasion of conventional antimicrobial therapy 134