Omar Hussam Jumaah (1), Abeer Mansour Abdel Rasool (2), Lina Abbas Naser (3)
General Background: Urinary tract infections (UTIs) remain a significant global health concern, frequently complicated by the rise of antimicrobial resistance (AMR) among common uropathogens. Specific Background: In Iraq, increasing rates of multidrug-resistant bacterial strains, particularly Escherichia coli and Klebsiella pneumoniae, have limited therapeutic options and complicated clinical management. Knowledge Gap: Despite numerous studies on global AMR, region-specific data on uropathogen prevalence and susceptibility profiles in northern Iraq remain scarce. Aims: This study aimed to determine the prevalence and antibiotic resistance patterns of bacterial isolates from UTI patients in Mosul, Iraq, to guide empirical treatment and inform antimicrobial stewardship. Results: Among 173 isolates, E. coli (34.7%), K. pneumoniae (23.1%), and Pseudomonas aeruginosa (17.3%) were predominant. The highest susceptibility was observed with Meropenem (95.4%) and Imipenem (92.5%), while Ciprofloxacin resistance reached 42.2%, indicating restricted treatment options. Novelty: The study provides the most recent regional data on uropathogen distribution and resistance trends in Mosul, integrating microbiological surveillance with demographic analysis. Implications: These findings underscore the urgent need for continuous resistance monitoring, rational antibiotic use, and local antimicrobial stewardship programs to curb the spread of resistant uropathogens and improve clinical outcomes.Highlight :
E. coli remains the leading uropathogen in UTIs, followed by K. pneumoniae and P. aeruginosa.
High resistance to Ciprofloxacin (42.2%) indicates limited treatment options.
Regular surveillance of antibiotic resistance is essential for effective therapy and control.
Keywords : Urinary Tract Infection (UTI), Uropathogens, Antibiotic Resistance, Prevalence, Antimicrobial Susceptibility
R. V. Sionov and D. Steinberg, "Targeting the Holy Triangle of Quorum Sensing, Biofilm Formation, and Antibiotic Resistance in Pathogenic Bacteria," Microorganisms, vol. 10, no. 6, p. 1239, 2022. Available: [https://doi.org/10.3390/microorganisms10061239](https://doi.org/10.3390/microorganisms10061239)
G. Mancuso, M. Midiri, C. Gerace, and G. Teti, "Bacterial Antibiotic Resistance: The Most Critical Pathogens," Pathogens, vol. 10, no. 10, p. 1310, 2021. Available: [https://doi.org/10.3390/pathogens10101310](https://doi.org/10.3390/pathogens10101310)
S. M’Aiber, N. H. Jaff, and M. Al-Ibrahimi, "The Challenge of Antibiotic Resistance in Post-War Mosul, Iraq: An Analysis of 20 Months of Microbiological Samples from a Tertiary Orthopaedic Care Centre," Journal of Global Antimicrobial Resistance, vol. 30, pp. 311–318, 2022.
M. A. Oudah, "Antibiotic Resistance Profile of Pathogenic Bacteria Isolated from Healthcare Rooms in the Mosul Government Hospital, Iraq," Medical Journal of Babylon, vol. 21, Suppl. 1, pp. S70–S80, 2024.
B. Singh, A. Bhat, and K. Ravi, "Antibiotics Misuse and Antimicrobial Resistance Development in Agriculture: A Global Challenge," Environmental Health, vol. 2, no. 9, pp. 618–622, 2024.
G. Muteeb, M. Khalid, and S. W. Siddiqui, "Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review," Pharmaceuticals, vol. 16, no. 11, p. 1615, 2023.
T. O. Kolawole, J. M. Olayinka, and P. S. Nwachukwu, "Innovative Strategies for Reducing Antimicrobial Resistance: A Review of Global Policy and Practice," Global Health Research and Policy, vol. 8, no. 1, p. 55, 2023.
S. Mudenda, J. M. Banda, and A. Chileshe, "Global Strategies to Combat Antimicrobial Resistance: A One Health Perspective," Pharmacology and Pharmacy, vol. 14, no. 8, pp. 271–328, 2023.
X. Yang, Z. Li, and Y. Zhao, "Disease Burden and Long-Term Trends of Urinary Tract Infections: A Worldwide Report," Frontiers in Public Health, vol. 10, p. 888205, 2022.
X. Li, M. Zhang, and J. Liu, "Global and Regional Burden of Bacterial Antimicrobial Resistance in Urinary Tract Infections in 2019," Journal of Clinical Medicine, vol. 11, no. 10, p. 2817, 2022.
S. von Vietinghoff, L. Bergman, and H. Haller, "The Global Burden of Antimicrobial Resistance–Urinary Tract Infections," Nephrology Dialysis Transplantation, vol. 39, no. 4, pp. 581–588, 2024.
Y. Zhou, L. Wang, and P. Chen, "Urinary Tract Infections Caused by Uropathogenic Escherichia coli: Mechanisms of Infection and Treatment Options," International Journal of Molecular Sciences, vol. 24, no. 13, p. 10537, 2023.
R. Kaur and R. Kaur, "Symptoms, Risk Factors, Diagnosis and Treatment of Urinary Tract Infections," Postgraduate Medical Journal, vol. 97, no. 1154, pp. 803–812, 2021.
H. Ehsan, M. Khan, and A. Rahimi, "Comprehensive Narrative Analysis of Antimicrobial Resistance in Afghanistan: Key Drivers, Challenges, and Strategic Interventions," Journal of Health, Population and Nutrition, vol. 44, p. 265, 2025.
R. N. Al-Zidan, S. M. Mahmood, and Z. M. Younus, "The Antibiotic Susceptibility Patterns of Uropathogens Among Adults with Recurrent Urinary Tract Infection in Mosul, Iraq," Pharmakeftiki, vol. 36, no. 2, 2024.
M. Iftikhar, T. Ullah, and N. Javed, "Antibiogram and Antibiotic Resistance Patterns in Bacterial Isolates from Hayatabad Medical Complex, Peshawar," Cureus, vol. 16, no. 10, 2024.
R. O. Chimezie, "Health Awareness: A Significant Factor in Chronic Diseases Prevention and Access to Care," Journal of Biosciences and Medicine, vol. 11, no. 2, pp. 64–79, 2023.
J. Rosário, M. Martins, and A. Silva, "Exploring Perceptions of Health Literacy, Healthcare Access, and Utilisation Among Higher Education Students in Alentejo, Southern Portugal: A Qualitative Study," PLoS One, vol. 20, no. 6, p. e0326575, 2025.
S. Ajabshir, N. Patel, and M. Khan, "Rate of Nutrition-Related Chronic Diseases Among a Multi-Ethnic Group of Uninsured Adults," Cureus, vol. 14, no. 9, 2022.
O. A. Alzomor, "Community Acquired Urinary Tract Infections in Children: Prevalence and Predictive Factors for ESBL Status of Uropathogen in a Tertiary Care Center in Saudi Arabia," M.S. thesis, Alfaisal University, Riyadh, Saudi Arabia, 2024.
R. J. Nhoro, "Aetiology and Antimicrobial Resistance Patterns of Urinary Tract Infections (UTIs) in Pregnant Women Attending Masvingo Provincial Hospital in 2023," Dissertation, University of Zimbabwe, Harare, 2024.
D. R. Ibrahim, "Prevalence of Plasmid Mediated QNRA, QNRB and QNRS Among Clinical Escherichia coli Isolated from Urinary Tract Infections in Duhok, Kurdistan Region of Iraq," Scientific Journal of University of Zakho, vol. 11, no. 4, pp. 523–531, 2023.
T. Ramatla, M. A. Kachigunda, and B. Molefe, "A Systematic Review and Meta-Analysis on Prevalence and Antimicrobial Resistance Profile of Escherichia coli Isolated from Water in Africa (2000–2021)," Heliyon, vol. 9, no. 6, 2023.
N. J. Verkaik, S. M. Kolesnyk, and M. K. Tokar, "Antimicrobial Susceptibility to Last-Resort Antibiotics in Carbapenemase-Producing Bacteria from Ukrainian Patients," Microbiology Spectrum, vol. 12, no. 11, p. e01142-24, 2024.
M. M. Rahman, A. H. Hossain, and K. Islam, "An Overview of Antimicrobial Stewardship Optimization: The Use of Antibiotics in Humans and Animals to Prevent Resistance," Antibiotics, vol. 11, no. 5, p. 667, 2022.
S. N. Khadse, S. Ugemuge, and C. Singh, "Impact of Antimicrobial Stewardship on Reducing Antimicrobial Resistance," Cureus, vol. 15, no. 12, 2023.
M. Oliveira, R. Pereira, and D. Costa, "An Overview of the Recent Advances in Antimicrobial Resistance," Microorganisms, vol. 12, no. 9, p. 1920, 2024.