Antimicrobial resistance trends in Escherichia coli uropathogens over a 10-year period in Duhok Province, Iraq: A retrospective cross-sectional study

Background: The rise in antimicrobial-resistant Escherichia coli (E. coli) strains pose a serious threat to global public health, necessitating coordinated efforts from government and the broader community to combat this growing challenge. This study aimed to analyze the antibiotic sensitivity of E. coli isolates from urine samples over a 10-Year Period collected from patients in Duhok, Kurdistan Region of Iraq. Methods: This cross-sectional study was conducted between December 2013 and January 2022. A total of 531 midstream urine samples were collected from patients with confirmed urinary tract infections. E. coli isolates were identified using standard culture methods and confirmed through biochemical testing. Antibiotic susceptibility testing was performed using the VITEK 2 system. Results: E. coli isolates exhibited the highest resistance rates in 2022, particularly against amoxicillin (84.2%). Overall, the most resistant antibiotics were amoxicillin (76.46%), ceftazidime (67.8%), and ceftriaxone (57.63%), while the highest sensitivity was observed for meropenem (95.86%) and imipenem (94.92%). Male patients exhibited higher resistance rates to several antibiotics, including ceftazidime, ceftriaxone, and ciprofloxacin (p ≤ 0.001), whereas no significant gender differences were observed for carbapenems or nitrofurantoin (p > 0.05). Conclusion: The findings indicate that E. coli isolates from urine samples demonstrated high resistance to amoxicillin, ceftazidime, and ceftriaxone, while maintaining high sensitivity to meropenem, imipenem, and amikacin. Gender-related differences in resistance were significant for several antibiotics, with higher resistance rates observed in male patients. Further multicenter studies across broader regions of Iraq are recommended to monitor and address the evolving resistance patterns of E. coli uropathogens.