Prevalence and distribution of multidrug-resistant bacteria isolated from pediatric clinical samples
DOI:
https://doi.org/10.32792/utq/utjsci/v13i1.1550Keywords:
Multidrug resistant bacteria, Paediatric infections, Hospital-acquired infectionsAbstract
Multidrug-resistant bacterial infections (MDRIs) represent a major global health concern, contributing to increased morbidity, mortality, prolonged hospital stays, and higher healthcare costs. In Iraq, data on antimicrobial resistance among pediatric patients remain limited. This retrospective cross-sectional study assessed the prevalence and microbiological characteristics of MDRIs among hospitalized pediatric patients under 11 years of age at the Central Children’s Teaching Hospital in Baghdad between March and October 2025, with confirmed positive bacterial cultures from different clinical samples, MDRIs were identified in 88.4% of patients, indicating a high prevalence. Multidrug resistance was the predominant pattern, particularly in Escherichia coli (96.5%) and Klebsiella pneumoniae (96.8%), while Acinetobacter baumannii was mainly extensively drug-resistant (XDR) (90.0%). Less common resistance phenotypes, including ESBL, VRE, ICR, and MRCNS, were also observed. Most isolates (76.8%) were obtained from stool and urine samples, with E. coli being the most frequent pathogen, whereas A. baumannii predominated in blood cultures. The high burden of MDR and XDR organisms underscores the urgent need for improved antimicrobial stewardship
Received: 04-01-2026
Revised: 15-05-2026
Accepted: 17-05-2026
References
U. Theuretzbacher, "Accelerating resistance, inadequate antibacterial drug pipelines and international responses," International Journal of Antimicrobial Agents, vol. 39, pp. 295–299, 2012, doi: 10.1016/j.ijantimicag.2011.12.006.
J. M. Munita and C. A. Arias, "Mechanisms of antibiotic resistance," Microbiology Spectrum, vol. 4, pp. 481–511, 2016, doi: 10.1128/microbiolspec.VMBF-0016-2015.
A. Bryce et al., "Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis," The Lancet, vol. 399, pp. 629–655, 2022, doi: 10.1016/S0140-6736(21)02724-0.
A. P. Magiorakos et al., "Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions," Clinical Microbiology and Infection, vol. 18, pp. 268–281, 2012, doi: 10.1111/j.1469-0691.2011.03570.x.
S. Qureshi et al., "Prevalence and risk factors associated with multidrug-resistant organism carriage among pediatric patients at admission in a tertiary care hospital of a developing country: a cross-sectional study," Qureshi et al. BMC Infectious Diseases, vol. 21, 2021, doi: 10.1186/s12879-021-06275-5.
Q. Yang et al., "Antimicrobial susceptibility among Gram-negative isolates in pediatric patients in Latin America, Africa-Middle East, and Asia from 2016–2020 compared to 2011–2015: ATLAS surveillance results," Journal of the Pediatric Infectious Diseases Society, vol. 12, pp. 459-470, 2023, doi: 10.1093/jpids/piad055.
M. T. Murray, M. P. Beauchemin, N. Neu, and E. L. Larson, "Prior antibiotic use and acquisition of multidrug-resistant organisms in hospitalized children: a systematic review," Infection Control & Hospital Epidemiology, vol. 40, no. 10, pp. 1107–1115, 2019, doi: 10.1017/ice.2019.215.
M. Ahmadi, R. Ranjbar, P. Behzadi, and T. Mohammadian, "Virulence factors, antibiotic resistance patterns, and molecular types of Klebsiella pneumoniae clinical isolates," Expert Review of Anti-infective Therapy, vol. 20, no. 3, pp. 463–472, 2022, doi: 10.1080/14787210.2022.1990040.
P. D. Tamma and A. J. Hsu, "Defining the role of novel β-lactam agents in carbapenem-resistant Gram-negative organisms," Journal of the Pediatric Infectious Diseases Society, vol. 8, no. 3, pp. 251–260, 2019.
D. M. P. De Oliveira et al., "Antimicrobial resistance in ESKAPE pathogens," Clinical Microbiology Reviews, vol. 33, p. e00181-19, 2020.
E. J. McGrath and B. I. Asmar, "Nosocomial infections and multidrug-resistant bacterial organisms in pediatric intensive care units," Indian Journal of Pediatrics, vol. 78, no. 2, pp. 176–184, 2011.
M. Girona-Alarcón et al., "Device-associated multidrug-resistant bacteria surveillance in critically ill children: 10 years of experience," Acta Paediatrica, vol. 110, no. 1, pp. 203–209, 2021.
A. H. Uc-Cachón et al., "High prevalence of antimicrobial resistance among Gram-negative bacilli in ICUs at a tertiary-care hospital in Yucatán, Mexico," Medicina, vol. 55, no. 9, p. 588, 2019.
D. C. Zaha et al., "Recent advances in investigation, prevention, and management of healthcare-associated infections: multidrug-resistant strain colonization and risk factors in a university hospital ICU," BioMed Research International, vol. 2019, p. 2510875, 2019.
Antimicrobial Resistance Collaborators, "Global burden of bacterial antimicrobial resistance in 2019: systematic analysis," The Lancet, vol. 399, pp. 629–655, 2022, doi: 10.1016/S0140-6736(21)02724-0.
J. P. Roy et al., "Emerging pathogens and resistance mechanisms shaping future pediatric antimicrobial resistance," Journal of Pure and Applied Microbiology, vol. 19, no. 2, pp. 834–847, 2025, doi: 10.22207/JPAM.19.2.46.
M. Sarshar, P. Behzadi, D. Scribano, A. T. Palamara, and C. Ambrosi, "Acinetobacter baumannii: an ancient commensal with weapons of a pathogen," Pathogens, vol. 10, no. 4, p. 387, 2021, doi: 10.3390/pathogens10040387.
P. Behzadi, Z. Baráth, and M. Gajdács, "A narrative review on the microbiology, virulence and therapeutic prospects of multidrug-resistant Pseudomonas aeruginosa," Antibiotics, vol. 10, no. 1, p. 42, 2021, doi: 10.3390/antibiotics10010042.
F. A. Saeedi et al., "Multidrug-resistant bacterial infections in pediatric patients hospitalized at King Abdulaziz University Hospital, Jeddah, Saudi Arabia," Children, vol. 11, p. 444, 2024, doi: 10.3390/children11040444.
G. Ali, "Antibiotic resistance patterns and multidrug-resistant bacteria in pediatric patients: a retrospective study," AlQalam Journal of Medical and Applied Sciences, vol. 5, pp. 810–815, 2025.
Z. El Zein et al., "The challenge of multidrug resistance in hospitalized pediatric patients with urinary tract infections," Frontiers in Cellular and Infection Microbiology, vol. 15, p. 1570405, 2025, doi: 10.3389/fcimb.2025.1570405.
C. A. Moxon and S. Paulus, "Beta-lactamases in Enterobacteriaceae infections in children," Journal of Infection, vol. 72, suppl., pp. S41–S49, 2016, doi: 10.1016/j.jinf.2016.04.021.
M. Mahony, B. McMullan, J. Brown, and S. E. Kennedy, "Multidrug-resistant organisms in pediatric urinary tract infections," Pediatric Nephrology, vol. 35, pp. 1563–1573, 2020, doi: 10.1007/s00467-019-04316-5.
S. S. Roul, L. Priyadarshini, and S. K. Pradhan, "Risk factors of multidrug-resistant urinary tract infection in children: a cross-sectional study," Research & Reviews: Pediatrics, vol. 23, pp. 16–20, 2022, doi: 10.4103/rrp.rrp_11_22.
N. P. Parajuli et al., "High rates of multidrug resistance among uropathogenic E. coli in children and analysis of ESBL producers from Nepal," Antimicrobial Resistance & Infection Control, vol. 6, p. 9, 2017, doi: 10.1186/s13756-016-0168-6.
A. M. Algammal et al., "AMR patterns and virulence of emerging multidrug-resistant Edwardsiella tarda in Nile tilapia and African catfish," Aquaculture, vol. 548, p. 737643, 2022.
N. Y. Abo et al., "The impact of antimicrobial stewardship in children in low- and middle-income countries: a systematic review," Pediatric Infectious Disease Journal, vol. 41, no. 3S, pp. S10–S17, 2022.
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