Vol. 7, Issue 2, Part C (2025)

Background: CA-UTIs is one of the predominant bacterial infections among pediatric patients worldwide, and it has a high impact on both the morbidity in the short-term and renal outcomes in the long-term [1]. Delayed diagnosis, inconsistent access to microbiological confirmation, and broad-spectrum antibiotics applied in the majority of the cases and instances of the UTI management in low-and-middle-income countries (LMICs), such as in Iraq, are often compromising the quality of the management [2, 3]. Though concerning regional reports of multidrug-resistant (MDR) uropathogens are alarming, there is an acute evidence gap that concerns both profile of pathogen and resistance patterns in rural Iraqi healthcare environment, whereby diagnostic and therapeutic resources are significantly limited [4].
Objective: This research paper sought to do a thorough description of the epidemiological, microbiological, and clinical situation of CA-UTIs among pediatrics of Al-Numaniyah General Hospital, which is a primary referral center that serves rural populations in wasit Governorate, Iraq. The objectives were: (1) to determine the prevalence and demographic associations of UTI in children aged 1 month to 12 years; (2) to identify the spectrum of causative uropathogen prevalence and antimicrobial susceptibility profiles with standardized methods; (3) to assess concordance between widely used empirical antibiotic treatment and culture directed definitive therapy, and (4) to establish independent predictors of treatment failure and MDR infection.
Methods: This was a prospective cohort study that was carried out in the outpatient and inpatient pediatric units and lasted 12 months (January 2024 to December 2024). Children with a clinical presentation that indicated the presence of UTI had a standardized urine collection (clean-catch midstream or catheterization where necessary). Two hours later, the urine cultures were put through blood and MacConkey agar using calibrated loops. AST was done using the Kirby-Bauer disk diffusion test based on Clinical and Laboratory standards Institute (2023) guidelines. Data on clinical, demographic and treatment outcomes were collected in a prospective manner with data analyzed using descriptive and inferential statistics with the use of multivariate logistic regression to control confounders.
Results: The median age was 2.1 years (IQR: 0.9 5.3), and 58.2 percent of 184 confirmed cases of UTI were female. Escherichia coli occupied the major percentage of 72.3, then Klebsiella pneumoniae (15.2) and Proteus mirabilis (6.5) in that order. The rates of resistance were quite high against E. coli: amoxicillin (68.4%), co-trimoxazole (54.1%), ceftriaxone (31.6%); nitrofurantoin showed low resistance (6.8%). Only 49.5% cases are in agreement with the AST results of the empirical antibiotic therapy. Failure to treatment was much higher with initial discordant treatment (22.8% vs. 5.3%; p<0.001). Multivariate analysis showed that previous antibiotic exposure in 30 days (adjusted OR=3.1, 95% CI: 1.85-5.4) and age below the age of 2 years (adjusted OR=2.4, 95% CI: 1.3-4.5) were independent risk factors of MDR UTI.
Conclusion: This paper presents an alarming AMR-carrying among pediatric uropathogens in an average rural hospital in Iraq. The observed discrepancy between empirical prescriptions and local resistance patterns is an urgent indication of the necessity of antimicrobial stewardship programs in hospitals and regular antibiograms. These results encourage implementation of context-dependent, evidence-based recommendations to standard pediatric practice, which is a needed measure to maintain the effectiveness of antibiotics and the fulfillment of Sustainable Development Goal 3 where resources are scarce.