Prevalence of multidrug, extensively drug and pan-drug resistant Escherichia coli in children’s urine samples in Duhok, Iraqi Kurdistan

Naqid, Ibrahim; Hussein, Nawfal; Hameed, Masood; Daniel, Shameran; Ahmad, Seepal; Mosa, Ahmed

doi:10.21608/mid.2025.336266.2345

Prevalence of multidrug, extensively drug and pan-drug resistant Escherichia coli in children’s urine samples in Duhok, Iraqi Kurdistan

Articles in Press

Document Type : Original Article

Authors

¹ Department of Biomedical Sciences Department, College of Medicine, University of Zakho, Kurdistan Region, Iraq

² Department of Basic Sciences, College of Dentistry, University of Duhok, Kurdistan Region, Iraq

³ Emergency Department of Azadi Teaching Hospital, Directorate of Health, Duhok, Kurdistan Region, Iraq

10.21608/mid.2025.336266.2345

Abstract

Background: Escherichia coli is identified as the main micro-organism causing Urinary Tract Infections (UTIs), which require effective antibiotic therapy. The development of Anti-Microbial Resistance (AMR) has further complicated therapeutic options. Therefore, this study aims to examine patterns of antimicrobial resistance among paediatric patients with UTIs. Methods: This retrospective cross-sectional study analysed data from 311 E. coli isolates obtained from children’s urine samples referred to a private clinic between November 26, 2016, and February 11, 2020. E. coli isolation and identification were performed using MacConkey and Blood agar media and then incubated at 37 °C for 24 hrs. Isolates that gave up colony counts of >10⁵ CFU/mL were considered as positive growth. Antibiotic susceptibility profile was detected using the Vitek-2 system. Results: The majority of the study participants were female (89.71%), and (75.24%) were in the 1-10 age groups. Out of total 311 isolates, almost all identified isolates (96.14%) were classified under at least one category of AMR. Among these, (56.86%) were classified as Multi Drug Resistance, (42.14%) as Extensively Drug Resistance, and (1%) as Pan-drug Resistance. Carbapenems (Imipenem and Meropenem) demonstrated highest effectiveness, with resistance rate of only (0.96%) and (1.61%), respectively. Conversely, resistance to Co-Amoxiclav and 3^rd generation Cephalosporins were observed. Patients in the age group 1-5 years had significantly highest level of MDR and XDR, with a p-value of 0.036. Conclusion: The rising antimicrobial resistance of E. coli in UTIs among children in Duhok Province represents an alarming trend, highlighting the urgent necessity for antimicrobial stewardship.

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