Prevalence, Etiology, and Antibiotic Resistance Patterns of Urinary Tract Infections in a Baghdad Hospital: Focus on Uropathogenic E. coli and Virulence Factors

Background Urinary tract infections (UTIs) remain one of the most common bacterial infections worldwide and represent a growing public health concern due to increasing antimicrobial resistance. Objective A cross‐sectional observational study conducted at a hospital in Baghdad, Iraq, analyzed patients that attended for uropathogenic Escherichia coli (UPEC). It sought to estimate UPEC prevalence in patients, identify etiological agents of UPEC infections, assess UPEC antimicrobial susceptibility, and examine UPEC virulence factors. Methods Between February and August 2024, there was a total of 182 midstream urine samples collected from patients clinically suspected of having a UTI. Bacteria were identified and antimicrobial susceptibility testing was performed via standard microbiological methods according to CLSI standards. Phenotypic assessments of biofilm formation, hemolysin production, and hemagglutination were performed on the E. coli isolates. Results The study has shown that 95 of the samples (52.2%) had a positive culture for significant bacteriuria. E. coli was overwhelmingly the most commonly isolated organism at 63.2%. Klebsiella spp. and other nonhemolytic Gram‐negative bacteria were also isolated. A high level of resistance to both ampicillin and trimethoprim–sulfamethoxazole was found, whereas the highest level of susceptibility to imipenem and nitrofurantoin was found. A percentage of 71.7% of UPEC organisms had the ability to form a biofilm, 41.7% demonstrated the ability to lyse red blood cells (hemolysis), and 58.3% had the ability to agglutinate RBCs (hemagglutination). Biofilm formation and the ability to agglutinate RBCs were found to be significantly related to either antimicrobial resistance at the univariate level ( p ≤ 0.05). Conclusion These findings highlight the ongoing burden of antimicrobial resistance among uropathogens in Baghdad and emphasize the importance of continuous surveillance and rational antibiotic use.