DefinePK

Abstract

Background & objective: Multidrug-resistant (MDR) Enterobacteriaceae, particularly Escherichia coli and Klebsiella pneumoniae, pose a critical global health threat owing to the limited therapeutic options. Increasing β-lactamase-mediated resistance requires local surveillance to inform treatment and control strategies.This research was carried out to determine the prevalence, antibiotic resistance patterns, and biofilm production of MDR Enterobacteriaceae in patients with urinary tract infections (UTI) across healthcare facilities in Al-Hilla, Iraq.Methodology: From September 2024 to April 2025, 215 bacterial isolates were collected from hospitalized and outpatient patients with known UTI in Al-Hilla. Species identification was performed using MacConkey agar, eosin methylene blue (EMB) agar, biochemical tests (IMViC), and the VITEK 2 system. Antibiotic susceptibility testing (16 antibiotics) was performed according to CLSI (2024) disk diffusion guidelines. Biofilm production was assessed using Congo red agar (CRA).Results: The results of our research show that E. coli (53%, 114/215) and K. pneumoniae (27%, 60/215) were the predominant pathogens. High rates of resistance were observed for ampicillin (E. coli, 99.1%; K. pneumoniae, 98.3%) and ceftazidime (E. coli, 70.2%; K. pneumoniae, 75%). Carbapenems showed low resistance (imipenem: E. coli, 12.3%; K. pneumoniae 20%). Biofilm production occurred in 52.6% of E. coli isolates (strong/moderate: 42.1%) and 68.3% of K. pneumoniae isolates (strong/moderate: 53.3%).Conclusion: MDR Enterobacteriaceae exhibiting significant β-lactam resistance and biofilm formation are prevalent in Al-Hilla UTI cases, underscoring a critical public health challenge. The correlation between biofilm production and MDR necessitates enhanced stewardship and the development of alternative therapeutic strategies.Abbreviations: E. coli, Escherichia coli; K. pneumoniae, Klebsiella pneumoniae; MDR, multidrug resistance; ESBL, extended-spectrum β-lactamase; UTI, urinary tract infection.
Keywords: Enterobacteriaceae, Escherichia coli, Klebsiella pneumoniae, Multidrug resistance, Biofilm, Urinary tract infection.Citation: Khaleel NA, Abbas MS, Mohsen LY. Prevalence and characterization of multidrug-resistant enterobacteriaceae from urinary tract infections in Al-Hilla, Iraq. Anaesth. pain intensive care 2025;29(7):712-218. DOI: 10.35975/apic.v29i7.2975Received: July 16, 2025; Revised: August 04, 2025; Accepted: August 10, 2025