Journal of Isfahan Medical School

Journal of Isfahan Medical School

Antimicrobial Susceptibility Patterns of Urinary Escherichia Coli Isolates Among Hospitalized Patients at Imam Khomeini Hospital, Ahvaz (2023 – 2025)

Document Type : Original Article (s)

Authors
Narges Eslami 1
Forouzan Ahmadianfar 2
Maryam Shooshtari-Khombi 3
1 Assistant Professor, Department of Pathology, School of Medicine, Imam Khomeini Hospital, Ahvaz, Iran
2 Department of Pathology, School of Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran
3 Assistant Professor, Chronic Renal Failure Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
10.48305/jims.v43.i841.1616
Abstract
Background: Given the alarming increase in antibiotic resistance and the diversity of resistance patterns in different geographical regions, this study aimed to determine the prevalence and antibiotic resistance pattern of Escherichia coli strains isolated from urinary tract infections.
Methods: This retrospective cross-sectional study was conducted to determine the prevalence and antibiotic resistance pattern of Escherichia coli (E. coli) isolated from urinary tract infections in patients hospitalized at Imam Khomeini Hospital in Ahvaz (2023-2025). Antibiotic susceptibility patterns for 13 common antibiotics were evaluated using the disk diffusion method.
Findings: Among 15465 urine cultures performed, 495 cases (3.2%) were positive, of which 199 cases (40.2% positive cases) were identified as E. coli. The antibiotic resistance pattern showed high susceptibility to nitrofurantoin (79%), carbapenems (75%), and aminoglycosides (57.5%), and high-grade resistance to penicillins (93.5%), quinolones (78.9%), and folate inhibitors (71%). Multidrug resistance (MDR) was observed in 38.2% of isolates. Resistance to aminoglycosides was significantly associated with underlying genitourinary disease and admission to the urology/nephrology department, and resistance to quinolones was also significantly associated with admission to the same department and age over 50 years.
Conclusion: It is concluded that E. coli was the most common cause of urinary tract infection in this study and has high resistance to ampicillin, first-generation cephalosporins, and fluoroquinolones. In contrast, meropenem, nitrofurantoin, and gentamicin have maintained appropriate susceptibility. These findings indicate the need to revise initial empirical treatment protocols and strengthen surveillance programs for the rational use of antibiotics.

Highlights

Narges Eslami: PubMed , Google Scholar

Maryam Khombi Shooshtari:  PubMed , Google Scholar 

Keywords
Urinary tract infection
Escherichia coli
Antibiotic resistance
Susceptibility pattern

Subjects

1.     Tullus K, Shaikh N. Urinary tract infections in children. Lancet 2020;3 95(10237): 1659-68.
2.     Yang SS, Tsai J-D, Kanematsu A, Han C-H. Asian guidelines for urinary tract infection in children. J Infect Chemother 2021; 27(11): 1543- 54.
3.     Boswell TC, Maric T, Khoury AE, Farrugia M-K. Urinary tract dilatation and vesicoureteral reflux-Adult outcomes, who should be followed, and how to follow them. J Pediatr Urol 2023; 19(4): 450-5.
4.     Nabat-ul-Hassan S, Farva K, Bhutta GA, Khan RN, Zia S, Ali U. Microorganism causing urinary tract infection among children and their antimicrobial susceptibility patterns. Rawal Medical Journal 2022; 47(1): 49-52.
5.     Khoshbakht R, Salimi A, Shirzad AH, Keshavarzi H. Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Karaj, Iran. Jundishapur J Microbiol 2012; 6(1): 86-90.
6.     Nateghian AR, Karaji S, Zamani K. A decade of trends in the distribution and antimicrobial susceptibility of prevalent uropathogens among pediatric patients from Tehran, Iran during 2005–2016. Asian J Urol 2021; 8(3): 253-9.
7.     Mamishi S, Shalchi Z, Mahmoudi S, Hosseinpour Sadeghi R, Haghi Ashtiani MT, Pourakbari B. Antimicrobial resistance and genotyping of bacteria isolated from urinary tract infection in children in an Iranian referral hospital. Infect Drug Resist 2020; 13: 3317-23.
8.     Piranfar V, Mirnejad R, Erfani M. Incidence and antibiotic susceptibility pattern of most common bacterial pathogen causing urinary tract infection (UTI) in Tehran, Iran 2012-13. International Journal of Enteric 2016; 2: 2.
9.     Lieu TA, Baskin MN, Schwartz JS, Fleisher GR. Clinical and cost-effectiveness of outpatient strategies for management of febrile infants. Pediatrics 1992; 89(6): 1135-44.
10.  Fitzgerald A, Mori R, Lakhanpaul M, Tullus K. Antibiotics for treating lower urinary tract infection in children. Cochrane Database Syst Rev 2012(8): CD006857.
11.  Gauthier M, Chevalier I, Sterescu A, Bergeron S, Brunet S, Taddeo D. Treatment of urinary tract infections among febrile young children with daily intravenous antibiotic therapy at a day treatment center. Pediatrics 2004; 114(4): e469-e76.
12.  Babaee Z, Amir Mozafari N, Forohesh H, Arashkia A, Mahdavi S, Bahrami A. Determination of drug sensitivity in Escherichia coli has multiple drug resistance in outpatients with UTI [in Persian]. Iran J Med Microbiol 2012; 6(3): 37-44.
13.  Arends SR, McCreary EK, Helgeson M, Morgan G, Patkar S, Mendes R. Retrospective analysis of antimicrobial resistance among Escherichia coli causing community-acquired urinary tract infections in the United States from 2010–2022. J Glob Antimicrob Resist 2025; 44: 442-8.
14.  Lezhenko H, Pashkova O, Samoylyk K, Petrashyna O. Results of bacteriological monitoring of urinary tract infections in children of Zaporizhzhia region in 2023. Eastern Ukrainian Medical Journal 12(2): 335-47.
15.  Isac R, Doros G, Stolojanu C-A, Steflea RM, Stroescu RF, Olariu I-C, et al. General characteristics and current state of antibiotic resistance in pediatric urinary tract infection—a single center experience. Antibiotics. Antibiotics (Basel) 2024; 13(8): 684.
16.  Khan MI, Xu S, Ali MM, Ali R, Kazmi A, Akhtar N, et al. Assessment of multidrug resistance in bacterial isolates from urinary tract-infected patients. Journal of Radiation Research and Applied Sciences 2020; 13(1): 267-75.
17.  Kot B. Antibiotic resistance among uropathogenic Escherichia coli. Pol J Microbiol 2019; 68(4): 403-15.
18.  Alizade H. Escherichia coli in Iran: An overview of antibiotic resistance: A review article. I Iran J Public Health 2018; 47(1): 1-12.
19.  Renda R. Diagnosis and antibiotic resistance distribution in children with urinary tract infection: a single center experience. International Journal of Pediatrics. 2018; 6(1): 6815-22.
20.  Niranjan V, Malini A. Antimicrobial resistance pattern in Escherichia coli causing urinary tract infection among inpatients. Indian J Med Res 2014; 139(6): 945-8.
21.  Madrazo M, Esparcia A, López-Cruz I, Alberola J, Piles L, Viana A, et al. Clinical impact of multidrug-resistant bacteria in older hospitalized patients with community-acquired urinary tract infection. BMC Infect Dis 2021; 21(1):1232.
Journal of Isfahan Medical School
Volume 43, Issue 841
1st Week , February
January and February 2026
Pages 1616-1625

  • Receive Date 28 January 2026
  • Accept Date 08 February 2026