Antimicrobial Resistance Patterns of Escherichia coli Isolates from Female Urinary Tract Infection Patients in Lebanon: An Age-Specific Analysis

Abstract

Urinary tract infections (UTIs) are a global health concern, with over 150 million cases annually, primarily caused by Escherichia coli. Due to anatomical differences, females, especially children and postmenopausal women, are four times more susceptible. Crucially, E. coli has developed widespread antimicrobial resistance (AMR), including resistance to broad-spectrum agents and the emergence of Extended-Spectrum Beta-Lactamase (ESBL)-producing strains. This retrospective study analyzed hospital records from 95 female patients with positive urine cultures at Siblin Governmental Hospital in 2024. Patients were stratified into three age categories: children (≤18 years), adults (18–64 years) and elderly patients (>64 years). Statistical analysis using SPSS focused on descriptive resistance patterns and differences across age groups. Overall, cephalothin (85.7%) and cefaclor (78.49%) exhibited the highest resistance rates. Conversely, tigecycline (97.22%) and ertapenem (91.67%) showed the highest susceptibility. Resistance patterns varied significantly by age. For instance, elderly patients showed high resistance to agents like Augmentin (52.5%) and cefixime (66.1%), while the pediatric group (≤18 years) displayed exceptionally high resistance to cefixime (90.0%). E. coli isolates show high resistance to conventionally used antibiotics, complicating UTI treatment. These findings highlight the need for continuous local surveillance, particularly focusing on third-generation cephalosporins and beta-lactamase production. Ultimately, age is a critical factor that must be considered when determining empirical antibiotic therapy for UTIs.

1. Introduction

Urinary tract infections (UTIs) affect approximately 150 million individuals worldwide annually, making them one of the most prevalent bacterial illnesses. Although UTIs impact both men and women, they are significantly more common in women, with nearly half of all women experiencing an infection at some point in their lives [1]. UTIs represent a major public health concern, causing morbidity and, in vulnerable populations such as infant boys, older men and women of all ages, even mortality. Furthermore, UTIs are the leading cause of subsequent bloodstream infections [2]. The global burden of UTIs is escalating, with an estimated 404.6 million infections recorded in 2019. This increase is driven by factors such as aging populations and the growing establishment of antimicrobial resistance (AMR) [3]. While medications are used to treat UTIs, recurrent infections are frequent, and many uropathogens are developing resistance to multiple drugs. This trend poses serious challenges for effective UTI management and necessitates research into new diagnostic and therapeutic strategies [4,5]. UTI prevalence also tends to be higher in certain regions, particularly those with lower socioeconomic indices, and generally rises with age, especially in women [6]. Approximately 10% of females experience a UTI yearly, and between 40% and 60% will likely have an infection during their lifetime [7]. The high frequency of antibiotic use is positively correlated with induced microbial resistance; as the number of infections across the lifespan increases, so does antibiotic consumption [8]. Antimicrobial susceptibility patterns provide critical insight into the efficacy of antibiotics against specific bacterial strains. These patterns can vary significantly depending on the geographical area and the isolate’s origin. The most frequent bacterial species causing UTIs is Escherichia coli (E. coli). This organism has acquired resistance to numerous antibiotics through natural resistance mechanisms and the frequent empirical use of antibiotics. Prescribing antibiotics based solely on symptoms, without prior urine culture and susceptibility testing, often leads to therapeutic failures and contributes substantially to the development of antibiotic resistance. One of the most critical issues is the emergence of extended-spectrum beta-lactamase (ESBL) and multidrug resistance (MDR), which have profoundly impacted antibiotic selection for treating severe E. coli infections [9]. For the early implementation years (2016–2020) of surveillance, priority has been given to tracking resistance in E. coli against several antibiotic classes, including carbapenems (doripenem, ertapenem, imipenem, meropenem), third-generation cephalosporins (ceftriaxone, ceftazidime, cefotaxime), fourth-generation cephalosporins (cefepime), fluoroquinolones, penicillin (ampicillin), sulfonamides and trimethoprim (co-trimoxazole) [10]. While the relationship between age and antimicrobial susceptibility is intricate—influenced by factors such as infection site, type and the patient’s medical history—age is still a significant determinant of antimicrobial resistance (AR). Huang and colleagues demonstrated that the microbial resistance spectrum differs dramatically across age groups [11]. Similarly, another study reported that most E. coli strains isolated from female patients over the age of 65 are resistant to two or more medications [7]. This study aims to present the resistance profile of E. coli isolates from female patients with UTIs at Siblin Governmental Hospital in Mount Lebanon. We analyzed resistance rates and patterns according to patient age. The findings from this research can help guide therapeutic care for E. coli infections, thereby reducing treatment failure and mitigating the evolution of resistance due to drug overuse.

2. Materials and Methods

2.1. Data Collection

Between January and February 2025, data were retrospectively collected for 95 female patients with positive urine cultures (≥100 CFU/mL) at Sibline Hospital. Strain resistance against 30 antibiotics (amikacin amk, augmentin amc, aztreonam atm, cefixime cfm, ceftazidime caz, ceftriaxone cro, cefuroxime cxm, cefoxitin fox, cefaclor cf, cephalothin cep, ciprofloxacin cip, trimethoprim/sulfa tmp/smx, nitrofurantoin nit, gentamycin gen, norfloxacin nor, ofloxacin ofx, piperacillin/tazobactam ptz, tetracycline tet, imipenem ipm, levofloxacin lvx, cefepime fep, cefotaxime ctx, colistin cst, fosfomycin fos, ertapenem ert, meropenem mem, tigecycline tgc, moxifloxacin mxf) was assessed using disk-diffusion method on Mueller–Hinton Agar. A strain was defined as multidrug-resistant (MDR) if it demonstrated acquired non-susceptibility to at least one agent in three or more different antimicrobial categories. The disk-diffusion method followed Clinical and Laboratory Standards Institute (CLSI) guidelines, and the reference strain Escherichia coli ATCC 25922 was used for quality control. The current analysis was strictly limited to 95 consecutive E. coli isolates from positive urine cultures; isolates non-E. coli were excluded from the analysis. The resistance rates were displayed as resistant strains among the tested strains for antibiotic agents. MDR strains are those demonstrating acquired non-susceptibility to at least one agent in three or more different antimicrobial categories, based on international standards. ESBL production was phenotypically confirmed using the combination disk method (cefotaxime and ceftazidime with and without clavulanic acid), adhering to CLSI guidelines Urine cultures were processed using standard hospital laboratory procedures. Bacterial isolates recovered from positive cultures were initially identified as presumptive E. coli using conventional microbiological methods. These methods included macroscopic examination of colony morphology on differential, Gram staining (demonstrating Gram-negative rods) and catalase/oxidase testing (typically catalase-positive, oxidase-negative). Final, definitive confirmation of the species identity was performed using an automated biochemical identification system available at the hospital laboratory (such as VITEK 2 or an equivalent platform), ensuring a high degree of accuracy before subsequent antimicrobial susceptibility testing.

2.2. Patient Age and Sample Type Subgroup Analyses

Only the first strain isolated from hospitalized patients was included, and repeated isolation and patient records were excluded. E. coli resistance analyses were performed based on the patients’ age. The female patients were divided into three groups based on their age: children (less than 18 years), young adults (18–64 year) and old adults (greater than 64 years).

2.3. Statistical Analysis

Differences in the resistance rates between different age groups was analyzed using the χ². The χ² test was used to compare the proportion of resistant isolates to each individual antibiotic agent across the three defined patient age categories. The data were analyzed using the SPSS 2021. p < 0.05 was considered significant. Given the exploratory and descriptive nature of this study, which aims to characterize local resistance patterns across distinct age strata, we utilized the Chi-squared (χ²) test to identify significant associations between patient age group and resistance to each individual antibiotic agent. It is crucial to note that no statistical correction (such as Bonferroni or false discovery rate) was applied to adjust for multiple comparisons performed across the antibiotic panel. Consequently, the reported p-values should be interpreted cautiously; while they indicate areas of potential age-dependent difference, they do not establish definitive, risk-adjusted associations. The results are primarily intended to highlight critical resistance trends for local empirical treatment guidance and to inform future, more focused studies.

2.4. Ethical Considerations

The study was approved by the research committee of Sibline governmental hospital in Mount Lebanon (reference number: 2024-0037) on 5 December 2024. The analysis relied on routinely gathered anonymized programmatic data. The research was operationally necessary, with the goal of assessing services and determining resource allocation. All methods were carried out in conformity with applicable standards and regulations.

3. Results

3.1. Socio-Demographic Characteristics of Patients with Uropathogenic E. coli (UPEC)

The study included ninety-five female patients (N = 95). These patients were separated according to age into three categories as follows: 20 (21.05%) samples were collected from children under 18, 16 (16.84%) samples belong to adult patients between 18 and 64 years and 59 (62.10%) from elderly who are above 64 years. The demographic characteristics of patients are summarized in

Table 1. Percentage of each age group.

Variable	Categories	Total n (%)
Age	<18	20 (21.05%)
	18–64	16 (16.84%)
	>64	59 (62.10%)

. The mean age is 58.78.

3.2. Antimicrobial Profile of UPEC

A descriptive analysis to determine the antimicrobial susceptibility of UPEC strains was carried out. The results showed that the highest resistance rate was against cephalothin cep (85.7%) followed by cefaclor (78.49%), cefixime (70.21%), cefotaxime (68.18%), cefuroxime (67.02%), ceftazidime (61.96%), ceftriaxone (59.57%), augmentin (54.74%) and ofloxacin (52.63%). on the other hand, highest susceptibility was toward tigecycline (97.22%) followed by ertapenem (91.67%), amikacin (91.49%), meropenem (87.21%), fosfomycin (82.56%), imipenem (82.22%), gentamycin (73.12%), nitrofurantoin (71.91%), aztreonam (70.42%) and piperacillin/tazobactam (70.13%) (

Table 2. Antimicrobial pattern of UPEC isolated from Sibline Hospital.

Antibiotics	Resistance	Intermediate	Susceptible
amikacin amk	4 (4.26%)	4 (4.26%)	86 (91.49%)
augmentin amc	52 (54.74%)	9 (9.47%)	34 (35.79%)
aztreonam atm	19 (26.76%)	2 (2.82%)	50 (70.42%)
cefixime cfm	66 (70.21%)	3 (3.19%)	25 (26.60%)
ceftazidime caz	57 (61.96%)	8 (8.70%)	27 (29.35%)
ceftriaxone cro	56 (59.57%)	3 (3.19%)	35 (37.23%)
cefuroxime cxm	63 (67.02%)	2 (2.13%)	29 (30.85%)
cefoxitin fox	27 (31.03%)	2 (2.30%)	58 (66.67%)
cefaclor cf	73 (78.49%)	1 (1.08%)	19 (20.43%)
cephalothin cep	60 (85.71%)	2 (2.86%)	8 (11.43%)
ciprofloxacin cip	39 (46.43%)	3 (3.57%)	42 (50.00)
trimethoprim/sulfa tmp/smx	48 (51.06%)	1 (1.06%)	45 (47.87%)
nitrofurantoin nit	19 (21.35%)	6 (6.74%)	64 (71.91%)
gentamycin gen	25 (26.88%)	0 (0%)	68 (73.12%)
norfloxacin nor	36 (49.32%)	1 (1.37%)	36 (49.32%)
ofloxacin ofx	40 (52.63%)	2 (2.63%)	34 (44.74)
piperacillin/tazobactam ptz	14 (18.18%)	9 (11.69%)	54 (70.13%)
tetracycline tet	38 (46.91%)	1 (1.23%)	42 (51.85%)
imipenem ipm	11 (12.22%)	5 (5.56%)	74 (82.22%)
levofloxacin lvx	37 (50.00%)	0 (0%)	37 (50.00%)
cefepime fep	28 (33.33%)	8 (9.52%)	48 (57.14%)
cefotaxime ctx	60 (68.18%)	4 (4.55%)	24 (27.27)
colistin cst	0 (0%)	0 (0%)	12 (100%)
fosfomycin fos	13 (15.12%)	2 (2.33%)	71 (82.56%)
ertapenem ert	5 (6.94%)	1 (1.39%)	66 (91.67%)
meropenem mem	10 (11.63%)	1 (1.16%)	75 (87.21%)
tigecycline tgc	0 (0%)	2 (2.78%)	70 (97.22%)
moxifloxacin mxf	36 (38.71%)	0 (0%)	57 (61.29%)

).

3.3. Distribution of Antibiotic Resistance Across Different Age Groups

The analysis of the data showed varying levels of antibiotic resistance across different age groups. the resistance to common antibiotics like augmentin (52.5%), ceftazidime (62.7%), ceftriaxone (64.4%), cefuroxime (69.5%), cephalothin (61.0%) and ciprofloxacin (50.8%) is higher in older age group (>64) compared to younger age groups. younger females (<18) notably exhibit high resistance to augmentin (80.0%), cefixime (90.0%), cefaclor (90.0%) and cefotaxime (65.0%). on the other hand, moderate to high resistance is recorded among adult groups (18–64) as follows cefaclor (68.8%), cephalothin (56.3%), cefixime (56.3%), ceftazidime (50.0%), cefuroxime (50.0%), ceftriaxone (43.8%) and levofloxacin (37.5%). There is a significant association between age groups and the antibiotic rate of the following antibiotics, augmentin, ciprofloxacin, gentamicin, norfloxacin, ofloxacin, piperacillin/tazobactam, tetracycline, levofloxacin, cefepime and fosfomycin. The results are summarized in

Table 3. Antibiotic Resistance by Age Groups.

	Age N (%)						Total	p Value
Antimicrobial Drugs	<18 (n = 20)		18–64 (n = 16)		>64 (n = 59)		95
AMK	1	5.0%	0	0.0%	3	5.1%	4	0.668
AMC	16	80.0%	5	31.3%	31	52.5%	52	0.012 *
ATM	1	5.0%	4	25.0%	14	23.7%	19	0.21
CFM	18	90.0%	9	56.3%	39	66.1%	66	0.06
CAZ	12	60.0%	8	50.0%	37	62.7%	57	0.55
CRO	11	55.0%	7	43.8%	38	64.4%	56	0.22
CXM	14	70.0%	8	50.0%	41	69.5%	63	0.22
FOX	8	40.0%	5	31.3%	14	23.7%	27	0.41
CF	18	90.0%	11	68.8%	44	74.6%	73	0.22
CEP	15	75.0%	9	56.3%	36	61.0%	60	0.39
CIP	4	20.0%	5	31.3%	30	50.8%	39	0.01 *
TMP/SMX	10	50.0%	7	43.8%	31	52.5%	48	0.22
NIT	4	20.0%	3	18.8%	12	20.3%	19	0.859
GEN	6	30.0%	2	12.5%	17	28.8%	25	0.01 *
NOR	2	10.0%	5	31.3%	29	49.2%	36	0.04 *
OFX	12	60.0%	6	37.5%	32	54.2%	40	0.008 *
PTZ	1	5.0%	4	25.0%	9	15.3%	14	0.032 *
TET	8	40.0%	4	25.0%	26	44.1%	38	0.009 *
IPM	4	20.0%	1	6.3%	6	10.2%	11	0.236
LVX	2	10.0%	6	37.5%	29	49.2%	37	0.01 *
FEP	5	25.0%	4	25.0%	19	32.2%	28	0.026 *
CTX	13	65.0%	8	50.0%	39	66.1%	60	0.497
FOS	1	5.0%	1	6.3%	11	18.6%	13	0.01 *
ERT	1	5.0%	1	6.3%	2	3.4%	4	1.01
MEM	4	20.0%	1	6.3%	5	8.5%	10	0.14
MXF	5	25.0%	6	37.5%	25	42.4%	36	0.11

* p < 0.05 (significant).

.

3.4. Distribution of Antibiotic Sensitivity Among Females with Different Age Groups

According to the data shown in

Table 4. Antibiotic sensitivity by Age Group.

	Age N (%)						Total
Antimicrobial Drugs	<18		18–64		>64		95
amk	19	95.0%	16	100.0%	51	86.4%	86
amc	3	15.0%	10	62.5%	21	35.6%	34
atm	2	10.0%	10	62.5%	38	64.4%	50
cfm	2	10.0%	7	43.8%	16	27.1%	25
caz	4	20.0%	7	43.8%	16	27.1%	27
cro	7	35.0%	8	50.0%	20	33.9%	35
cxm	6	30.0%	6	37.5%	17	28.8%	29
fox	6	30.0%	10	62.5%	42	71.2%	58
cf	2	10.0%	5	31.3%	12	20.3%	19
cep	0	0.0%	4	25.0%	4	6.8%	8
cip	7	35.0%	10	62.5%	25	42.4%	42
tmp/smx	9	45.0%	9	56.3%	27	45.8%	45
nit	14	70.0%	11	68.8%	39	66.1%	64
gen	13	65.0%	14	87.5%	41	69.5%	68
nor	1	5.0%	11	68.8%	24	40.7%	36
ofx	1	5.0%	10	62.5%	23	39.0%	34
ptz	3	15.0%	10	62.5%	41	69.5%	54
tet	10	50.0%	9	56.3%	23	39.0%	42
ipm	13	65.0%	13	81.3%	48	81.4%	74
lvx	1	5.0%	10	62.5%	26	44.1%	37
fep	5	25.0%	11	68.8%	32	54.2%	48
ctx	4	20.0%	7	43.8%	13	22.0%	24
fos	16	80.0%	13	81.3%	42	71.2%	71
ert	2	10.0%	14	87.5%	50	84.7%	66
mem	7	35.0%	15	93.8%	53	89.8%	75
tgc	8	40.0%	14	87.5%	48	81.4%	70
mxf	15	26.31%	10	17.54%	32	56.14%	57

, adult females aged between 18 and 64 showed the highest sensitivity to most antimicrobial drugs including aminoglycosides (AMK 100% and GEN 87.5%), beta lactams (amc 62.5%, cro 50%, caz 43.8%, cxm 37.5%, cf 31.3%, cep 25%), fluoroquinolones (mxf 87.5%, nor 68.8%, cip 62.5%, ofx 62.5%, lvx 62.5%), sulfonamides (tmp/smx 56.3%), fos 81.3%, carbapenems (mem 93.8%, ert 87.5%,), tetracyclines (tet 56.3%). ATM exhibited the highest sensitivity in the over 64 age group, with a sensitivity rate of 64.4%, as for fox and ptz sensitivity rate was 71.2% and 69.5%, respectively. Meanwhile, females under 18 age showed lowest sensitivity to most of the antibiotics tested but had high sensitivity to amk (95%), followed by fos (80%), nit (70%)—the highest among all age groups—gen (65%) and ipm (65%).

3.5. Extended Spectrum Beta-Lactamase (ESBL) vs. Non-ESBL and MDR vs. Non-MDR

According to the descriptive analysis performed and summarized in

Table 5. ESBL/non-ESBL and MDR/non-MDR across age groups.

Variable	Categories	ESBL	Non-ESBL	MDR	Non MDR
Age	<18	12 (22.2%)	8 (19.51%)	11 (30.56%)	9 (15.25%)
	18–64	7 (12.96%)	9 (21.95%)	4 (11.11%)	12 (30.34%)
	>64	35 (64.81%)	24 (58.54)	21 (58.33%)	38 (64.41%)
	Total	54 (56.84%)	41 (43.16%)	36 (37.89%)	59 (62.11%)
	p-value	0.36		0.45

, the age group <18 had a higher percentage of multidrug-resistant (MDR) (30.56%) compared to non MDR (15.25%). This age group showed relatively similar proportions of ESBL-producing and non-ESBL strains. In the age group 18–64, the non MDR percentage (30.34%) was higher compared to MDR (11.11%). In the age group > 64 higher prevalence of both ESBL-producing (64.81%) and MDR strains (58.33%) compared to non-ESBL (58.54%) and non-MDR (64.41%). There was no significant difference in the prevalence of MDR and non-MDR across different age groups (p = 0.45), similarly for ESBL and non-ESBL (p = 0.36).

3.6. Antimicrobial Profile of MDR E. coli

The analysis revealed that out of 95 samples, 36 (37.89%) were identified as MDR E. coli strains. The results showed that MDR isolates were significantly resistant to commonly used antibiotics including cefixime (100.0%), cefuroxime (97.2%), ceftriaxone (94.4%) also cefotaxime (94.4%), cefaclor (92.7%). On the other hand, moderate resistance was recorded with ciprofloxacin (72.2%), ceftazidime (83.3%), augmentin (83.3%) and tmp/smx (69.4%). However, moxifloxacin showed a relatively lower resistance compared to other antibiotics (69.4%).

3.7. Antimicrobial Profile of ESBL E. coli

Out of 95 samples, 54 (56.84%) E. coli strains were ESBL producing UPEC. Among all antibiotics tested in this study for ESBL, carbapenems, amikacin, tigecycline, fosfomycin, nitrofurantoin and gentamycin were most active against E. coli isolates. On the other hand, high resistance was observed against cephalosporins including cefixime, cefuroxime, cefaclor also cephalothin, ceftriaxone (94.3%) and ceftazidime (87.04%), while moderate resistance was recorded to ofloxacin, norfloxacin, levofloxacin, ciprofloxacin and augmentin (

Table 6. Antimicrobial profile of ESBL producing UPEC.

Antibiotics	Resistance		Intermediate		Sensitive
amikacin	3	5.56%	3	5.56%	48	88.89%
augmentin	32	59.26%	5	9.26%	17	31.48%
aztreonam	18	46.15%	2	5.13%	19	48.72%
cefixime	54	100.0%	0	0.00%	0	0.00%
ceftazidime	47	87.04%	5	9.26%	2	3.70%
ceftriaxone	50	94.34%	1	1.89%	2	3.77%
cefuroxime	53	98.14%	0	0.00%	0	0.00%
cefoxitin	18	36.00%	1	2.00%	31	62.00%
cefaclor	53	98.14%	0	0.00%	0	0.00%
cephalothin	40	74.07%	0	0.00%	0	0.00%
ciprofloxacin	31	64.58%	1	2.08%	16	33.33%
trimetha/sulfa	33	62.26%	1	1.89%	19	35.85%
nitrofurantoin	16	31.37%	2	3.92%	33	64.71%
gentamycin	17	32.69%	0	0.00%	35	67.31%
norfloxacin	28	68.29%	0	0.00%	13	31.71%
ofloxacin	30	69.77%	2	4.65%	11	25.58%
piperacillin/tazobactam	10	23.26%	5	11.63%	28	65.12%
tetracycline	28	58.33%	1	2.08%	19	39.58%
imipenem	10	20.00%	3	6.00%	37	74.00%
levofloxacin	28	66.67%	0	0.00%	14	33.33%
cefepime	28	59.57%	8	17.02%	11	23.40%
cefotaxime	49	90.74%	0	0.00%	0	0.00%
fosfomycin	11	22.45%	1	2.04%	37	75.51%
ertapenem	5	12.50%	1	2.50%	34	85.00%
meropenem	6	12.24%	1	2.04%	42	85.71%
tigecycline	0	0.00%	1	2.56%	38	97.44%
moxifloxacin	29	55.77%	0	0.00%	23	44.23%

).

4. Discussion

Bacterial antimicrobial resistance (AMR) is linked to over 4.71 million deaths worldwide, a figure projected to rise to 8.22 million deaths by 2050. South Asia, Latin America and the Caribbean are expected to experience the highest mortality rates across all age groups [12]. E. coli is becoming highly resistant to conventionally used antibiotics, making infections more difficult to treat. Since urinary tract infections (UTIs) are more prevalent in women, research has largely focused on them. The incidence of UTIs increases with age, affecting up to 20% of women over 65, primarily due to weakened immune systems and reduced estrogen levels [13].

This study included 95 female patients of different age groups enrolled at Sibline Hospital. We fully acknowledge that the limited time frame (two months) and sample size (N = 95) are limitations of this retrospective study, but the data remains valuable as a critical first local report on antimicrobial resistance profiles in hospitalized female UTI patients across different age groups in this specific hospital setting in Lebanon. The data analysis revealed that antibiotics such as amikacin, ertapenem, meropenem and imipenem demonstrated high effectiveness with low resistance. In contrast, antibiotics like cefaclor, cephalothin, cefixime and cefotaxime showed high resistance, which limits their effectiveness in treating infections. Amikacin and nitrofurantoin were the most effective against E. coli isolates across all age groups. This data aligns well with previous studies indicating that E. coli strains from UTI are most susceptible to amikacin and carbapenems, while the highest resistance was recorded to cephalosporins, with antibiotic resistance being higher in the elderly relative to that in younger patients. However, even pediatric patients exhibited levels of decreased sensitivity to several antibiotics [14,15].

Multidrug-resistant (MDR) E. coli causing UTIs is a serious public health concern that can lead to treatment failure. In this study, 36 (37.89%) out of 95 (100%) samples were identified as MDR E. coli strains, with the elderly (>64 years) exhibiting the highest percentage (58.33%). This data is compatible with a study conducted in China, which found that multidrug resistance tends to increase with age and is more serious in geriatric patients [11]. The profile shows high resistance to multiple antibiotics, which indicates a challenging situation for treating infections caused by E. coli. cefixime and cefuroxime show full and high resistance, making them ineffective for treatment, while Moxifloxacin and Trimethoprim/Sulfamethoxazole showed moderate sensitivity, suggesting that these drugs can still be a treatment option. Similar results were provided in Zambia about the increase in the resistance of E. coli toward SXT [16] and toward ctx and cro in other studies conducted in Iraq [17].

Extended-spectrum beta-lactamase (ESBL) can inactivate most beta-lactam antibiotics, including broad-spectrum cephalosporins and penicillin. In this study, 56.84% of the urine isolates were ESBL-positive strains resistant to cephalosporins and fluoroquinolones, which indicates significant challenges in treating UTIs with common antibiotics and highlights the need for careful antibiotic selection. However, carbapenems, fosfomycin and nitrofurantoin appear to still be effective against these strains. Despite the small sample size in this study, a notable proportion of ESBL cases were observed in children (12, or 22.2%) and older adults (35, or 64.81%). Several studies highlighted the increased risk of ESBL-producing bacteria, including E. coli, in both the elderly and children, especially with recurrent UTIs, while fosfomycin and nitrofurantoin remain active against ESBL. A similar study conducted in the United States found that the prevalence of ESBL E. coli increased in both community and healthcare-associated settings and identified old adults (>65) as being at significant risk for ESBL E. coli bacteriuria [18,19].

5. Conclusions

Antimicrobial resistance (AMR) in E. coli is a growing global health issue that necessitates careful antibiotic selection. Antibiotics such as amikacin, ertapenem and imipenem consistently demonstrate high effectiveness with low resistance, whereas drugs like cefaclor, cephalothin, cefixime and cefotaxime show high resistance. This resistance profile presents a significant challenge in treating infections, particularly urinary tract infections (UTIs), which are more prevalent in women. Resistance patterns significantly vary by patient age and whose incidence increases with age. This underscores the critical importance of considering age when selecting antibiotic treatment for E. coli infections to ensure effective management and reduce associated mortality and morbidity.