Investigation of the Most Common Specimens in the Pediatric Hospital in Kirkuk and the Epidemiology of Predominant Bacteria Using Multiple Antibiotic Resistance Indices
Authors: Hameed Sh. Al-Wandawy Abbas , Abdulhady Zwain Luma 
Published: January 2025

Background: Urinary tract infections (UTIs) are among the most prevalent infectious diseases in children and are a leading cause of antibiotic use and pediatric hospitalization. Objectives: This study aimed to investigate the most common specimens and determine the frequency of Multiple Antibiotic Resistance Indexes (MARI) for predominant bacteria in the pediatric hospital of Kirkuk. Methods: A total of 299 different samples were collected from the pediatric hospital in Kirkuk province between May 1st and October 1st. The samples were cultured on blood agar, mannitol agar, and MacConkey agar and incubated for 24 hours at 37°C. Identification was based on morphological and microscopic examination, as well as the API kit. Results: The results showed that most of the samples were urine, with 221 samples collected. Of these, 66 (28.50%) showed positive growth, and 155 (71.49%) showed negative growth. Blood samples were the second most common, with 51 samples collected, of which 4 (9.61%) were positive, and 47 (90.38%) were negative. Stool samples amounted to 13, with 2 (15.38%) showing positive growth, and 11 (84.61%) showing negative growth. Cerebrospinal fluid (CSF), throat swab, and vaginal swab samples amounted to 11, 2, and 1, respectively, with no bacterial growth observed in them. The majority of isolates were from urine, with Escherichia coli being the most common species (28 isolates, 42.42%). Other species isolated included Klebsiella pneumoniae (13 isolates, 19.69%), Staphylococcus spp. (12 isolates, 19.05%), Enterobacter spp. (7 isolates, 10.61%), and Pseudomonas spp. (4 isolates, 6.06%). Proteus spp. and Streptococcus spp. each accounted for 1 isolate (1.25%). The bacteria isolated from blood were Acinetobacter spp., Enterobacter spp., Pseudomonas spp., and Klebsiella spp., each representing 1 isolate (1.25%) of the total. Two (100%) E. coli isolates were obtained from stool samples. E. coli isolates from urine were resistant to ampicillin (Am), tetracycline (Te), amoxicillin/clavulanic acid (AMC), and doxycycline (Do). Klebsiella spp. were resistant to Am, Staphylococcus spp. to erythromycin (E) and azithromycin (AZM), Enterobacter spp. to amikacin (AK) and AMC, and Pseudomonas aeruginosa to gentamicin (CN), all exhibiting 100% resistance. The MARI was greater than 0.2 in 27 isolates of E. coli (96.42%), 13 isolates of Klebsiella spp. (100%), 11 isolates of Staphylococcus spp. (91.66%), 7 isolates of Enterobacter spp. (100%), and 4 isolates of P. aeruginosa (100%). Conclusions: The current study concludes that urinary tract infection is the most common pathological condition among the young age group. Urine is one of the most frequently examined samples, with E. coli being the most predominant pathogen. The study also highlights the prevalence of antibiotic-resistant bacteria, as evidenced by the elevated MARI in isolates of E. coli, K. pneumoniae, Enterobacter spp., and Pseudomonas spp.