Prevalence and antimicrobial resistance patterns of bacterial uropathogens among pediatric patients in Muthanna Province Iraq

Abstract Background Bacterial urinary tract infections (UTIs) are among the most common bacterial infections in children. The prevalence and etiological patterns of pediatric UTIs vary based on demographic and environmental factors. Methods This retrospective registry-based study analyzed the etiological profiles and antibiotic resistance patterns of UTIs categorized by gender, residence, and age groups using a large (5-year) dataset from the Tertiary Maternity and Pediatric Hospital in Muthanna Province, Iraq. Results Females and rural patients exhibited a higher proportion of total culture-positive cases. Significant age-related differences were also observed. UTI rates were peaked in July and October, and children aged 3–12 were more susceptible than other age groups. Polymicrobial infections were identified in 3% of cases and were more common in urban male children. The most common uropathogens included Escherichia coli, Staphylococcus haemolyticus, Enterococcus faecalis, Klebsiella pneumoniae, Proteus mirabilis, and Staphylococcus aureus, while other uropathogens were detected at lower frequencies. Antimicrobial susceptibility testing revealed high resistance to several commonly used antibiotics. However, carbapenems, colistin, fosfomycin, vancomycin, tigecycline, doxycycline, and nitrofurantoin remained among the most effective therapeutic options. Urinary nitrite and leukocyte esterase tests demonstrated greater sensitivity and specificity for diagnosing bacterial UTIs than hematuria and proteinuria tests. Conclusion The results suggest considerable diversity in bacterial uropathogens and notable antimicrobial resistance among pediatric UTI cases in Muthanna Province, underscoring the importance of monitoring local resistance trends when selecting empirical therapy.