Patterns of antibiotic resistance in common paediatric infections: A study from hospitals in Southern Iraq

Abstract

Background: Antibiotic resistance presents a global public health challenge, with a more pronounced threat in conflict-affected settings. Southern Iraq offers a distinct concern, as decades of destruction to its health care system have become compounded challenges to identifying and treating pediatric infection. Objective: To describe the patterns of antibiotic resistance in common pediatric infection in three prominent Southern hospitals in Iraq, and to explore the primary trends in resistance. Methods: We conducted a retrospective cross-sectional study from January 2023 through December 2024 in three tertiary care hospitals across Basrah, Nasiriyah, and Diwaniyah. Clinical samples were collected from 1,847 pediatric patients (age range 0-16 years) with culture-confirmed bacterial infection. This was made possible through identification of all bacteria and antimicrobial susceptibility testing using both automated systems and disc testing for antimicrobial resistance. Results: The leading pathogenic bacteria were Escherichia coli (34.2%), Klebsiella pneumoniae (18.7%), and Staphylococcus aureus (16.3%). Detection of extended-spectrum beta-lactamase (ESBL) was noted in 42.8% of E. coli isolates and 51.3% of K. pneumoniae isolates. Methicillin-resistant S. aureus (MRSA) was 68.4% of S. aureus isolates. The rates of resistance were concerningly high with ampicillin (78.2%), cefotaxime (65.4%), and trimethoprim-sulfamethoxazole (61.7%) in pediatric populations in Southern Iraq. The rates of resistance to the carbapenems and amikacin and colistin were the lowest (< 15%). Conclusions: Pediatric infections in Southern Iraq are at alarmingly high rates of multi-drug resistance, including ESBL-producing Enterobacteriaceae and MRSA. This indicates a pressing need for enhanced efforts in antimicrobial stewardship programs and infection control.