Clinical Impact of Multidrug-Resistant Uropathogens in Urinary Tract Infections in Baghdad: A Cross-Sectional Study

UTIs are among the most widespread bacterial infections worldwide. The emergence of multi-drug resistant (MDR) uropathogenic bacteria has become a significant challenge in the treatment of UTIs in Baghdad hospitals, leading to increased morbidity, prolonged hospitalization, and elevated healthcare expenditures. To determine the frequency of MDR uropathogenic bacteria in adult patients with UTIs in selected hospitals in Baghdad, evaluate their clinical outcomes, characterize antimicrobial resistance, and assess clinical factors. A cross-sectional study from October 2025 through January 2026 at three hospitals in Baghdad. Patients admitted for suspected urinary tract infection and aged at least 18 years provided midstream urine samples. Samples were cultured, bacteria were identified using standard microbiological techniques, and antimicrobial susceptibility testing was performed using the Kirby–Bauer Disk Diffusion Method according to CLSI guidelines. MDR was defined as resistance to ≥3 antimicrobial classes. Data on demographics, medical history, prior antibiotic use, and hospitalizations were collected. Of 612 urine samples, 456 (74.5%) demonstrated significant growth. E. coli (58.8%), K. pneumoniae (18.0%), and P. aeruginosa (9.6%) were predominant. MDR prevalence was 63.2% (n=288), highest in K. pneumoniae (78.5%). Significant associations existed between MDR and recurrent UTI history (p<0.01), prior antibiotic exposure (p<0.01), and catheter use (p=0.02). MDR infections showed longer hospital stays (8.5 ± 3.1 vs 5.2 ± 2.4 days; p<0.001) and more complications. The high prevalence of MDR highlights the importance of antimicrobial stewardship, resistance monitoring, and the development of alternative therapeutic strategies.