The Emergence of Multidrug-Resistant (MDR), Extensively Drug-Resistant (XDR), and Pandrug-Resistant (PDR) In Iraqi Clinical Isolates of Escherichia coli

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Halah M.H. Al-Hasani
Dalal S. Al-Rubaye
Dalal S. Al-Rubaye
Alyaa Abdelhameed


Antimicrobial-resistant bacteria, Escherichia coli, Extensively drug-resistant (XDR), Multidrug-resistant (MDR), Pandrug-resistant (PDR).


Antimicrobial-resistant bacteria consider one of the world's most pressing health issues. One of the most significant bacteria that can show multiple antimicrobial resistance patterns e.g., Resistance to many drugs, including XDR and PDR strains (PDR) is Escherichia coli, which, has been shown to increase in the rates of resistance to different categories of antimicrobial agents. The current study aims to investigate the emergence of antimicrobial resistance patterns in the clinical isolates of E.coli among patients in Baghdad city. The results showed that out of 500 different clinical specimens, 113 (22.60%) isolates were identified as E.coli, and the percentage of E.coli isolation in females (54.87%) when compared to men (45.13%). More than half (51.33%) of the isolates obtained came from urine. Patients younger than 20 years old accounted for 33% of all E. coli samples taken. Most E. coli isolates revealed a pattern of strong resistance to the majority of the commonly used antibiotics, as determined by antimicrobial susceptibility testing. Piperacillin, amoxicillin, ceftazidime, ceftriaxone, cefepime, ciprofloxacin, azithromycin, and tetracycline were all antibiotics that the isolates exhibited extreme resistance. and the percentage of resistance were 96.46%, 95.58%, 92.92%, 92.04%, 90.27%, 84.96%, 84.07%, 82.30%, and 80.53% respectively. However, most E.coli isolates were highly sensitive to Meropenem (82.30%), followed by Piperacillin-tazobactam and Imipenem which both had susceptible rates reach to 69.91%. Most E.coli isolates (98.23%) were classified as MDR, 21.24% were classified as XDR, and 1.77% were classified as possibly PDR. Concludingly, most E.coli isolates were MDR, additionally, XDR and possibly PDR have been emerged. Which revealed a severe and critical health problem that could threaten the community and healthcare settings.

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1. Assafi MS, Ali FF, Polis RF, Sabaly NJ, Qarani SM. An epidemiological and multidrug resistance study for E. coli isolated from urinary tract infection (three years of study). Baghdad Sci.J. 2022;19(1):7–15.
2. Naqid IA, Balatay AA, Hussein NR, Saeed KA, Ahmed HA, Yousif SH. Antibiotic Susceptibility Pattern of Escherichia coli Isolated from Various Clinical Samples in Duhok City, Kurdistan Region of Iraq. Int J Infect. 2020 Jun 10;7(3).
3. Saeb Sabri T, Kareem AA. Genotyping diversity of Echerichia coli isolated from UTI in iraqi patients. Medico-Legal Update. 2020 Jan 1;20(1):1421–7.
4. Yu D, Banting G, Neumann NF. A review of the taxonomy, genetics, and biology of the genus Escherichia and the type species Escherichia coli. Can J Microbiol. 2021;67(8):553–71.
5. Aabed K, Moubayed N, Alzahrani S. Antimicrobial resistance patterns among different Escherichia coli isolates in the Kingdom of Saudi Arabia. Saudi J Biol Sci. 2021 Jul 1;28(7):3776–82.
6. Patil S, Chen X, Lian M, Wen F. Phenotypic and genotypic characterization of multi-drug-resistant Escherichia coli isolates harboring blaCTX-M group extended-spectrum β-lactamases recovered from pediatric patients in Shenzhen, southern China. Infect Drug Resist. 2019;12:1325–32.
7. AL-Samarraie MQ, Omar MK, Yaseen AH, Mahmood MI. The wide spread of the gene haeomolysin (Hly) and the adhesion factor (Sfa) in the E. coli isolated from UTI. Journal of Pharmaceutical Sciences and Research. 2019 Apr 1;11(4):1298-303.
8. Kibret , Abera B. Antimicrobial susceptibility patterns of E. coli from clinical sources in northeast Ethiopia. Vol. 11, Afr Health Sci. 2011.
9. Saeed MA, Haque A, Ali A, Mohsin M, Bashir S, Tariq A, et al. A profile of drug resistance genes and integrons in E. coli causing surgical wound infections in the Faisalabad region of Pakistan. J Antibiot. 2009 Jun;62(6):319–23.
10. Qiu J, Jiang Z, Ju Z, Zhao X, Yang J, Guo H, et al. Molecular and Phenotypic Characteristics of Escherichia coli Isolates from Farmed Minks in Zhucheng, China. Biomed Res Int. 2019;2019.
11. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection. 2012;18(3):268–81.
12. Hassan R, Tantawy M, Gouda NA, Elzayat MG, Gabra S, Nabih A, et al. Genotypic characterization of multiple drug resistant Escherichia coli isolates from a pediatric cancer hospital in Egypt. Sci Rep. 2020 Dec 1;10(1).
13. Mohammad AS. Antimicrobial susceptibility of Escherichia coli isolates from clinical specimens in children over a 5-year period in Jordan. Biomedical and Pharmacology Journal. 2016;9(1):9–13.
14. Galindo-Méndez M. Antimicrobial Resistance in Escherichia coli . In: E coli Infections - Importance of Early Diagnosis and Efficient Treatment. IntechOpen; 2020.
15. Ali SA, Al-Dahmoshi HOM. Detection of Efflux Pumps Gene and Relation with Antibiotics Resistance in Uropathogenic Escherichia coli (UPEC) Isolated from Patients with Cystitis.IJS. 2022;63(6):2388–97.
16. Fodor A, Abate BA, Deák P, Fodor L, Gyenge E, Klein MG, et al. Multidrug resistance (MDR) and collateral sensitivity in bacteria, with special attention to genetic and evolutionary aspects and to the perspectives of antimicrobial peptides—a review. Vol. 9, Pathogens. MDPI AG; 2020. p. 1–55.
17. Roque‐borda CA, da Silva PB, Rodrigues MC, Azevedo RB, di Filippo L, Duarte JL, et al. Challenge in the discovery of new drugs: Antimicrobial peptides against who‐list of critical and high‐priority bacteria. Vol. 13, Pharmaceutics. MDPI AG; 2021.
18. Weinstein MP, Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 30th ed. 2020. 282 p.
19. AL-khazraji. Prevalence of Extended-Spectrum β-lactamases among Multidrug-resistant Escherichia coli clinical isolates and their Correlation to plasmid profile. College of Science, University of Baghdad ; 2021.
20. Carroll KC, Hobden JA, Miller S, Morse SA, Mietzner TA, Detrick Barbara, et al. Jawetz, Melnick & Adelberg’s medical microbiology. 27th ed. 2016.
21. Brown AE, Smith HR. Benson’s Microbiological Applications Laboratory Manual in General Microbiology. 14th. McGraw-Hill Education; 2017.
22. Holt JG, N.R. Krieg, P.H.A. Sneath, J.T. Staley, S.T. Williams. Bergy,s Manual of Determinative Bacteriology. 9th. Williams &Wilkins, USA; 1994.
23. Al-doury SM, Al-Nasrawi MA, AL-Samarraie MQ. The molecular sequence of Giardia lamblia by using (tpiA) and (tpiB). International Journal of Drug Delivery Technology. 2019;9(03):374-7.
24. Molina F, López-Acedo E, Tabla R, Roa I, Gómez A, Rebollo JE. Improved detection of Escherichia coli and coliform bacteria by multiplex PCR. BMC Biotechnol. 2015 Jun 4;15(1).
25. Odongo I, Ssemambo R, Kungu JM. Prevalence of Escherichia coli and Its Antimicrobial Susceptibility Profiles among Patients with UTI at Mulago Hospital, Kampala, Uganda. Interdiscip Perspect Infect Dis. 2020;2020.
26. Sabir S, Anjum AA, Ijaz T, Ali MA, Khan M ur R, Nawaz M. Isolation and antibiotic susceptibility of E. coli from urinary tract infections in a tertiary care hospital. Pak J Med Sci. 2014;30(2):389–92.
27. Subedi K, Karki F, Lama S, Pandey A, Dahal U, Paudyal R. Phenotypic detection of Extended Spectrum Beta lactamase production from E. coli and K. pneumoniae in urinary samples among children. Tribhuvan University Journal of Microbiology. 2020 Dec 26;7:75–82. 28. AL-Lami RA, Al-Hayanni HSA, Shehab ZH. Molecular Investigation of Some Beta-lactamase Genes by PCR and DNA Sequencing Techniques in clinical Escherichia coli. IJS. 2022 Oct 30;4205–12.
29. Hounmanou YMG, Bortolaia V, Dang STT, Truong D, Olsen JE, Dalsgaard A. ESBL and AmpC β-Lactamase Encoding Genes in E. coli From Pig and Pig Farm Workers in Vietnam and Their Association With Mobile Genetic Elements. Front Microbiol. 2021 Mar 11;12.
30. Mohammed RK, Ibrahim AA. Distribution of dfrA1 and cat1 antibiotic resistance genes in uropathogenic Escherichia coli isolated from teens pregnant women in Iraq. IJS. 2022;63(8):3340–53.