Prevalence and Antibiotic Resistance Patterns of Asymptomatic Bacteriuria and Fungiuria among Older Adults in Sulaymaniyah, Iraqi Kurdistan Region, Iraq

Abstract

Background: Asymptomatic bacteriuria (ASBU) is common in older persons, leading to inappropriate use of antibiotics. Its prevalence and patterns of antibiotic resistance in Iraq are inadequately reported locally.

Objectives: This study aimed to determine the prevalence, microbial etiological profile, and antimicrobial resistance patterns associated with ASBU and fungiuria among older adults in Sulaymaniyah, Iraq.

Methods: A descriptive cross-sectional study was conducted from December 2024 to April 2025. Sixty asymptomatic senior volunteers (≥60 years old) were recruited from community and nursing care settings. Midstream urine samples were collected, examined microscopically, and cultured on Blood, MacConkey, and Sabouraud dextrose agars. The VITEK 2 system (bioMérieux) was employed to identify isolates. The CLSI M100 (2024) criteria were used to perform and interpret antimicrobial susceptibility testing.

Results: 8 out of 60 samples (13.3%) showed significant bacteriuria (≥10⁵ CFU/mL). 62.5% of the positive cases were women, most between the ages of 60 and 83. The most prevalent isolates were Escherichia coli (3.3%) and Klebsiella spp. (3.3%). After these, there were Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus agalactiae, and Candida albicans (1.7%). There was resistance to many drugs, especially in Klebsiella oxytoca, E. coli, and P. aeruginosa. Ciprofloxacin, amikacin, and nitrofurantoin were the most effective therapies, while ampicillin, erythromycin, and cloxacillin were less successful.

Conclusion: Asymptomatic bacteriuria and fungiuria were identified among older adults in Sulaymaniyah, with Gram-negative bacteria being the predominant isolates. However, the small sample size limits broad generalization of the antimicrobial resistance findings. Several isolates demonstrated antimicrobial resistance, emphasizing the importance of antimicrobial stewardship and avoiding unnecessary treatment in asymptomatic individuals.

Keywords: Asymptomatic bacteriuria; Elderly population; Antibiotic resistance; Urine culture; Sulaymaniyah.