Comparative Efficacy of Third and Fourth-Generation Cephalosporins against Escherichia coli and Klebsiella pneumoniae Isolates from Recurrent Urinary Tract Infections in Al-Najaf Province
Abstract
Urinary Tract Infection (UTI) Urinary tract infections are among the most common infections worldwide. They are most often caused by bacteria entering the urethra from the skin or rectum. The most common bacterial causes of UTIs worldwide are Escherichia coli and Klebsiella pneumoniae, and women and the elderly are most affected. In recent years, these two bacteria have become more resistant to traditional antibiotics due to the production of enzymes ESBL that make them difficult to treat. This study included two main axes, the first was the isolation of Escherichia coli and Klebsiella pneumoniae from the urine of patients suffering from recurrent urinary tract infections, the second axis includes a study of the effect of the cephalosporin group commonly used in hospitals to treat urinary tract infections. Within the framework of this study, (31) isolates of Escherichia coli and (17) isolates of Klebsiella pneumoniae were isolated from a group of patients with recurrent urinary tract infections. After conducting a sensitivity test for the isolates in this study using a group of generations of Cephalosporin, which are widely used in hospitals, they showed high resistance to most generations. E. coli showed high resistance to ceftriaxone at a rate of 93.5%, followed by Cefepime 87.1%, Cefdinir 74.2%, Cefixime 64.5%. While Klebsiella pneumoniae gave higher resistance to cefixime 88%, followed by Cefdinir 87.5%, Ceftriaxone 87.5%, Cefepime 76.4%. Therefore, caution should be exercised when using these treatments excessively, especially in cases of recurrent infections and the use of alternative treatments to reduce resistance.
References
X. Yang, H. Chen, Y. Zheng, S. Qu, H. Wang, and F. Yi, “Disease burden and long-term trends of urinary tract infections: A worldwide report,” Front. Public Health, vol. 10, p. 888205, 2022.
S. Biswas, R. Rana, M. Bal, S. Pati, M. Suar, and M. Ranjit, “Escherichia coli associated urinary tract infection: Epidemiology and possible strategies for control,” One Health Bull., vol. 5, no. 2, pp. 51–57, 2025.
N. Aggarwal and S. W. Leslie, “Recurrent Urinary Tract Infections,” in StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, Jan. 2025. [PMID: 32491411].
A. Sabih and S. W. Leslie, “Complicated Urinary Tract Infections,” in StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, Dec. 2024–Jan. 2025. [PMID: 28613784].
A. O. Hassan, B. O. Ojo, and A. O. Abdulrahman, “Escherichia coli as a global pathogen,” Funksec Here, vol. 3, no. 1, pp. 239–260, 2021.
R. Kucheria, P. Dasgupta, S. Sacks, M. Khan, and N. Sheerin, “Urinary tract infections: new insights into a common problem,” Postgrad. Med. J., vol. 81, no. 952, p. 83, 2005.
C. Caneiras, L. Lito, J. Melo-Cristino, and A. Duarte, “Community- and hospital-acquired Klebsiella pneumoniae urinary tract infections in Portugal: virulence and antibiotic resistance,” Microorganisms, vol. 7, no. 5, p. 138, 2019.
Y. Mouanga-Ndzime, C. Bisseye, N. M. Longo-Pendy, M. Bignoumba, A. C. Dikoumba, and R. Onanga, “Trends in Escherichia coli and Klebsiella pneumoniae urinary tract infections and antibiotic resistance over a 5-year period in southeastern Gabon,” Antibiotics, vol. 14, no. 1, p. 14, 2024.
W. C. Hsieh and S. W. Ho, “Evaluation of antibacterial activities of cephalosporin antibiotics: cefazolin, cephaloridine, cephalothin, and cephalexin,” Chin. J. Microbiol., vol. 8, no. 1, pp. 1–11, 1975.
D. B. Sunjaya, R. J. Lennon, V. H. Shah, P. S. Kamath, and D. A. Simonetto, “Prevalence and predictors of third-generation cephalosporin resistance in the empirical treatment of spontaneous bacterial peritonitis,” Mayo Clin. Proc., vol. 94, no. 8, pp. 1499–1508, Aug. 2019.
A. E. Maraolo, M. Cascella, S. Corcione, A. Cuomo, S. Nappa, G. Borgia, … and I. Gentile, “Management of multidrug-resistant Pseudomonas aeruginosa in the intensive care unit: state of the art,” Expert Rev. Anti-Infect. Ther., vol. 15, no. 9, pp. 861–871, 2017.
A. Klingeberg, N. Willrich, M. Schneider, G. Schmiemann, I. Gágyor, D. Richter, … and T. Eckmanns, “The Percentage of Antibiotic Resistance in Uncomplicated Community-Acquired Urinary Tract Infections: Findings of the RedAres Project,” Dtsch. Ärztebl. Int., vol. 121, no. 6, p. 175, 2024.
G. Schmiemann, A. Greser, A. Maun, J. Bleidorn, A. Schuster, O. Miljukov, … and I. Gágyor, “Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial,” BMJ, vol. 383, 2023.
F. L. Turcu, I. A. Vacaroiu, A. E. Balcangiu-Stroescu, A. R. Mitrea, D. Miricescu, D. G. Balan, and A. M. Stanigut, “Recurrent Urinary Tract Infections in Female Patients—A Clinical Review,” J. Mind Med. Sci., vol. 12, no. 1, p. 5, 2025.
B. Foxman, R. Barlow, H. D'Arcy, B. Gillespie, and J. D. Sobel, “Urinary tract infection: self-reported incidence and associated costs,” Ann. Epidemiol., vol. 10, no. 8, pp. 509–515, 2000.
S. Bhuiya, S. Kaushik, J. Logheeswaran, P. Karthika, R. Prathiviraj, J. Selvin, and G. S. Kiran, “Emergence of recurrent urinary tract infection: Dissecting the mechanism of antimicrobial resistance, host-pathogen interaction, and hormonal imbalance,” Microb. Pathog., p. 107698, 2025.
L. Emody, M. Kerenyi, and G. Nagy, “Virulence factors of uropathogenic Escherichia coli,” Int. J. Antimicrob. Agents, vol. 22, pp. 29–33, 2003.
M. A. Vagarali, S. G. Karadesai, C. S. Patil, S. C. Metgud, and M. B. Mutnal, “Haemagglutination and siderophore production as the urovirulence markers of uropathogenic Escherichia coli,” Indian J. Med. Microbiol., vol. 26, no. 1, pp. 68–70, 2008.
C. Hennequin and F. Robin, “Correlation between antimicrobial resistance and virulence in Klebsiella pneumoniae,” Eur. J. Clin. Microbiol. Infect. Dis., vol. 35, no. 3, pp. 333–341, 2016.
R. N. Al-Zidan, S. M. Mahmood, and Z. M. Younus, “The antibiotic susceptibility patterns of uropathogens among adults with recurrent urinary tract infection in Mosul, Iraq,” Pharmakeftiki, vol. 36, no. 2, 2024.
J. H. Al-Eqaby, A. H. Al-Charrakh, and A. A. Mustafa, “Resistance to third-generation cephalosporins among hospitalized patients with monomicrobial Enterobacteriaceae bacteremia (mEB) in Baghdad, Iraq,” J. Pharm. Negat. Results, vol. 13, no. 8, pp. 1–9, 2022.
A. Chander and C. D. Shrestha, “Prevalence of extended spectrum beta lactamase producing Escherichia coli and Klebsiella pneumoniae urinary isolates in a tertiary care hospital in Kathmandu, Nepal,” BMC Res. Notes, vol. 6, no. 1, p. 487, 2013.
W. Adamus-Białek, A. Baraniak, M. Wawszczak, S. Głuszek, B. Gad, K. Wróbel, … and P. Parniewski, “The genetic background of antibiotic resistance among clinical uropathogenic Escherichia coli strains,” Mol. Biol. Rep., vol. 45, no. 5, pp. 1055–1065, 2018.
A. Bougouizi, A. D. Tagueha, D. Scribano, Z. Chekroud, Z. E. I. Lamraoui, L. Nencioni, … and H. Rahab, “Third-generation cephalosporin-resistant uropathogenic Escherichia coli from community- and hospital-acquired infections show high level of antibiotic resistance and specific virulence traits,” Can. J. Infect. Dis. Med. Microbiol., vol. 2025, no. 1, p. 9021465, 2025.
M. H. Dirar, N. E. Bilal, M. E. Ibrahim, and M. E. Hamid, “Prevalence of extended-spectrum β-lactamase (ESBL) and molecular detection of blaTEM, blaSHV and blaCTX-M genotypes among Enterobacteriaceae isolates from patients in Khartoum, Sudan,” Pan Afr. Med. J., vol. 37, no. 1, 2020.
S. M. Maveke, “Phenotypic and molecular characterization of extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae in clinical isolates at Embu Level Five Hospital and Kenyatta National Hospital, Kenya,” Ph.D. dissertation, Univ. of Nairobi, 2023.
Copyright (c) 2025 Enas Jalil Baqer Al-Mayali, Taghreed F. Almahbobi

This work is licensed under a Creative Commons Attribution 4.0 International License.



