https://doi.org/10.4081/aiua.2026.14715
Incidence and pattern of antimicrobial resistance of main bacterial isolates from patients with communityacquired urinary tract infections in North of Iraq
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 3 February 2026
Introduction: Urinary tract infections (UTIs) are among the most common bacterial infections, with Escherichia coli as the leading cause. Increasing antimicrobial resistance has reduced the effectiveness of standard empirical treatments, making continuous monitoring essential. This study evaluated the bacterial causes of community-acquired UTIs and their resistance patterns to commonlyused antibiotics.
Methods: A descriptive cross-sectional study was conducted from November 2023 to July 2025 on patients presenting with symptoms of community-acquired UTI. Demographic and clinical data were collected with a structured form, and urine samples were subjected to culture and antimicrobial susceptibility testing. Patients with recent hospitalization, urinary procedures, catheterization, anatomical abnormalities, or pregnancy were excluded. Data were analyzed using SPSS v22, applying descriptive and comparative statistics with significance set at p<0.05.
Results: Among 453 patients, 509 culture-positive samples were identified; 82% were female. Gram-negative organisms dominated (69.2%), with E. coli as the most frequent pathogen (44.4%). High resistance rates were observed to ampicillin, trimethoprim, and nalidixic acid. In contrast, carbapenem resistance remained low, and nitrofurantoin retained good activity. Staphylococcus haemolyticus showed the highest overall resistance burden. Older age, male sex, and comorbidities such as diabetes, renal insufficiency, and hypertension were significantly associated with increased antimicrobial resistance.
Conclusions: Community-acquired UTI pathogens in Sulaimani showed high resistance to widely used oral antibiotics, while carbapenems and nitrofurantoin remained effective. Higher resistance was especially noted among older adults, men, and patients with diabetes or renal disease. These findings highlight the need for improved empirical therapy and ongoing resistance surveillance.
Downloads
1. Vakilzadeh MM, Heidari A, Mehri A, et al. Antimicrobial resistance among community-acquired uropathogens in Mashhad,Iran. J Environ Public Health 2020;2020:e3439497. DOI: https://doi.org/10.1155/2020/3439497
2. Stapleton AE, Wagenlehner FME, Mulgirigama A, Twynholm M. Escherichia coli resistance to fluoroquinolones in community-acquired uncomplicated urinary tract infection in women: a systematic review. Antimicrob Agents Chemother. 2020; 64:e00862-20. DOI: https://doi.org/10.1128/AAC.00862-20
3. Zavala-Cerna MG, Segura-Cobos M, Gonzalez R, et al. the clinical significance of high antimicrobial resistance in community-acquired urinary tract infections. Can J Infect Dis Med Microbiol 2020; 2020:e2967260. DOI: https://doi.org/10.1155/2020/2967260
4. Silva A, Costa E, Freitas A, Almeida A. Revisiting the frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections. Antibiotics. 2022; 11:768. DOI: https://doi.org/10.3390/antibiotics11060768
5. Selekman RS, Shapiro DJ, Copp HL. MP54-09 Antimicrobial exposure and uropathogen resisitance: an analysis of individual patient data from RCTs on antibiotic prophylaxis and the prevention of UTI. J Urol. 2015; 193:e668. DOI: https://doi.org/10.1016/j.juro.2015.02.2032
6. Ahmed SS, Shariq A, Alsalloom AA, et al. Uropathogens and their antimicrobial resistance patterns: Relationship with urinary tract infections. Int J Health Sci 2019; 13:48-55.
7. Lee DS, Lee SJ, Choe HS. Community-acquired urinary tract infection by escherichia coli in the era of antibiotic resistance. BioMed Res Int 2018;2018:7656752. DOI: https://doi.org/10.1155/2018/7656752
8. Guclu E, Halis F, Kose E, et al. Risk factors of multidrug-resistant bacteria in community-acquired urinary tract infections. Afr Health Sci. 2021; 21:214-9. DOI: https://doi.org/10.4314/ahs.v21i1.28
9. Naqid IA, Balatay AA, Hussein NR, et al. Bacterial strains and antimicrobial susceptibility patterns in male urinary tract infections in Duhok Province, Iraq. Middle East J Rehabil Health Stud. 2020; 7:e103529 DOI: https://doi.org/10.5812/mejrh.103529
10. Shrestha LB, Baral R, Khanal B. Comparative study of antimicrobial resistance and biofilm formation among Gram-positive uropathogens isolated from community-acquired urinary tract infections and catheter-associated urinary tract infections. Infect Drug Resist. 2019; 12:957-63. DOI: https://doi.org/10.2147/IDR.S200988
11. Hama-Soor TA, Salih SS, Muhamad SJ. The β-lactamase profile of Escherichia coli isolates from patients with urinary tract infections in teaching hospital in Sulaimani, Iraq. Ann Parasitol. 2021; 67:659-665.
12. Assafi MS, Ali FF, Polis RF, et al. An epidemiological and multidrug resistance study for E. coli isolated from urinary tract infection (three years of study). Baghdad Sci J. 2021; 19:7-15. DOI: https://doi.org/10.21123/bsj.2022.19.1.0007
13. Ibrahim M, Khalid HM, Mer WMS. The prevalence of uropathogenic Escherichia coli strains among outpatients with urinary tract infection in Zakho Hospitals-Zakho City, Duhok Province/Iraq. Al-Qadisiyah J Pure Sci. 2021; 26:26-40. DOI: https://doi.org/10.29350/qjps.2021.26.5.1366
14. Raheem RSA, Hussein MA, Al-Din NI. Causative organism of urinary tract infection and drug resistance in children at child's Central Teaching Hospital in Baghdad City. J Pak Med Assoc. 2019;69:S59-S63.
15. Al-Barzinji R, Esmahil SE, Sulaiman SS, et al. Effect of some antimicrobial agents on isolated bacteria from patients with urinary tract infection in Kurdistan Region. Zanco J Med Sci. 2010; 14:61-67. DOI: https://doi.org/10.15218/zjms.2010.024
16. Mouhammed K, Gdoura R. Study of the genomic characterization of antibiotic-resistant Escherichia Coli isolated from Iraqi patients with urinary tract infections. Indian J Microbiol. 2024; 64:457-466. DOI: https://doi.org/10.1007/s12088-023-01123-3
17. Abdulrahman IS. Antimicrobial susceptibility pattern of pathogenic bacteria causing urinary tract infections at Azadi Hospital in Duhok City, Kurdistan Region of Iraq. Sci J Univ Zakho. 2018; 6:46-50. DOI: https://doi.org/10.25271/2018.6.2.435
18. Kurdi A, Hasan AJ, Baker KI, Seaton RA, et al. A multicentre point prevalence survey of hospital antibiotic prescribing and quality indices in the Kurdistan regional government of Northern Iraq: The need for urgent action. Expert Rev Anti Infect Ther. 2021; 19:805-814. DOI: https://doi.org/10.1080/14787210.2021.1834852
19. Rashid KJ, Babakir-Mina M, Abdilkarim DA, et al. bacteriological profile and antibacterial sensitivity patterns of isolates among burn patients in Sulaimani. Kurdistan J Appl Res. 2017; 2. DOI: https://doi.org/10.24017/science.2017.2.8
20. Qadir AN, Mahmoud BM, Mahwi TO, et al. Prevalence of microorganisms and antibiotic sensitivity among patients with diabetic foot ulcer in Sulaimani City, Iraq. Hosp Pract Res. 2020; 5:56-63. DOI: https://doi.org/10.34172/hpr.2020.11
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.