Uropathogenic Klebsiella pneumoniae is considered the most important causes of urinary tract infection, and recently the antibiotic resistance of this pathogen has increased dramatically. The study aims at investigating the prevalence and antibiotic sensitivity of uropathogenic K. pneumoniae among different ages of groups at both genders. 1737 urine specimens were collected from individuals admitted to Zakho emergency hospital from January 2016 until December 2018. K. pneumoniae was identified based on Gram stain, colony characteristics and biochemical tests, and then it was tested for their antibiotic sensitivity. Out of all samples, 1076 (61.9%) showed significant bacterial yield. The UTIs among females (64.3%) were statistically higher than males (46.5%) (P < 0.001). The age group of 20-29 years was highly susceptible to UTIs (43%). Among the total UTIs, K. pneumoniae represented 16.2%. K. pneumoniae in males (23.4%) was significantly higher than females (15.4%) (P=0.03). The age group 40-49 years (32.2%) was the highest group that at risk for K. pneumoniae infection. K. pneumoniae was highly susceptible to imipenem (100%) and was highly resistant against cephalothin (90.8%). A high prevalence of UTIs were observed among the age group of 20-29 years and the females had more risk of having UTIs. The males were more susceptible to K. pneumoniae with higher prevalence in the age group of 40-49 years. K. pneumoniae showed high sensitivity toward imipenem and high resistance to cephalothin. More awareness is required in all healthcare sectors for regular surveillance of the use of antimicrobial agents to reduce the resistance rates and to eradicate the pathogens.

Uropathogenic E. coli (UPEC) is problematic and still the leading cause of urinary tract infections worldwide. It is developed resistance against most antibiotics. The investigation, surveillance system, and efficient strategy will facilitate selecting an appropriate treatment that could control the bacterial distribution. The present study aims to investigate the epidemiology and associated risk factors of uropathogenic E. coli and to study their antibiotic resistance patterns. 1585 midstream urine specimens were collected from symptomatic urinary tract infections (UTI) patients (225 males and 1360 females) admitted to Zakho emergency hospital, Zakho, Kurdistan Region, Iraq from January 2016 until the end of December 2018. Specimens were inoculated on blood and MacConkey plates and incubated at 37 о C for 24 hours. Uropathogenic E. coli was diagnosed based on gram staining, colony characteristics, and standard biochemical tests in accordance with local standards and guidelines. All isolates were screened for their antibiogram pattern using the disk diffusion method based on the Clinical and Laboratory Standards Institute guidelines. The results showed that out of 1585 urine specimens, 1026 (64.7%) were UTIs positive with a statistically higher rate in 2016 (83.6%) (P< 0.0001). The UTIs frequency in females was significantly higher than males (P< 0.0001). Generally, the uropathogenic E. coli represented 21.1% with the highest level in 2016 (22.9%). The uropathogenic E. coli rate was higher, statistically not significant, in females (21.4%) than males (18.5%) (P=0.4946). Additionally, through the three years of study, uropathogenic E. coli (UPEC) was in high frequency in February and May 2016. The female's age group from 20 to 39 years was the most vulnerable (46%) form total infected females, while those from 70-74 years (1%) were the least susceptible in males and females. A high percentage (80.56 %) of multidrug resistance E. coli isolates was observed with high resistance against -lactamase and macrolides antibiotics. However, higher sensitivity was towards imipenem and meropenem. In conclusion, the wrong and overuse of antibiotics will increase the resistance rate of E. coli. For this reason, proper use of available antibiotics is necessary. Also, the educational programs and periodic monitoring of antimicrobial susceptibility are essential for reducing the antibiotic resistance rate.

Background and objective: Siwak, Miswak, or Arak (Salvadora persica ) belongs to Salvadoraceae and is considered as the most widely used twigs since early times by Babylonians some 7000 years ago, it was later used throughout the Greek and Roman empires, and has also been used by ancient Egyptians and Muslims. The aim of this study was to determine the antibacterial activities of different extracts of Siwak on the growth of different oral isolates of Streptococcus mutans, Staphylococcus aerus and Candida albicans. Methods: Experiments were conducted in the laboratories of the College of Science, University of Salahaddin and College of Dentistry, Hawler Medical University for a period from Jun. 2008 to Feb. 2009, to determine the effects of different Siwak (Salvadora persica) extracts at concentrations of 500, 1000, 5000 and 10000 µg/ ml on the growth of different oral isolates of Streptococcus mutans, Staphylococcus aureus, and Candida albicans. Results: The results showed that all Siwak extracts (especially Siwak aqueous extract) were effective against Streptococcus mutans. and Staphylococcus aureus. The strongest antibacterial activity was observed using the concentrations of 10000 µg/ ml. While Siwak extracts were ineffective against Candida albicans. Conclusion: Siwak extracts had significant antibacterial effect against Streptococcus mutans. and Staphylococcus aureus, and ineffective against Candida albicans.

Refugees are under a high-risk factor of being suffering from many different diseases due to the uncontrolled accommodations environment of the camps. This study aimed to test whether the camp's habitat affecting the physical activities of the married females as a biomarker of the adverse effects on the health management issues. 60 married females (30 refugees and 30 city residents) were recruited. Blood samples of all participants were analyzed for blood glucose, blood triglycerides, blood cholesterol, blood hemoglobin (HGb), blood heamatocrite percentage (HCT %) and other physical parameters estimated like body mass index (BMI), mean arterial pressure (MAP). Additionally, participants were screened for bacterial UTIs. Refugees married females showed a significant decrease in the blood hemoglobin concentration (gm/dl) compared with the city females (P= 0.014) and blood heamatocrite percentage (HCT %) (P= 0.0074). Also, no significant differences were observed for the other parameters between refugees married females and city married females. The UTI bacterial infection in refugees married females (21, 65.6%) was significantly higher than the infection among city resident married females (11, 34.4%) (P=0.0096). The higher incidence percentage of UTIs were caused by Gram-negative bacteria (87.5%). The most dominant pathogen which established UTIs was Escherichia coli (57%). A high-stress level of camp environment and nutritional malformation may affect the refugees married females more than the city females. Therefore, it is the international community responsibility to protect and provide life-saving assistance to all refugee women and to those that have been subjected to such situations.

Background: Acute otitis media (AOM) is one of the most common inflammatory disorders particularly in infants. Multiple factors such as gender, using bottle-feeding formula, and exposure to cigarette smoking are thought to raise the incidence of AOM. In infants at age six months or less, Streptococcus pneumoniae is the most common causative bacteria of AOM. The complications of pneumococcal infections are due to increasing the rate of antibiotic resistance among the S. pneumoniae strains that coincides with the increased use of antibiotics and multidrug resistant which severely limits the therapeutic options and poses a great threat to public health. Objective: To determine the antibiotic resistance patterns of S. pneumoniae in infants aged six months or less with AOM as the most frequently isolated bacterial pathogens and the most possible risk factors such as parent smoke and bottle feeding that may increase the incidence of acute otitis media in infants. Patients and Methods: A total of 148 infants six months of age or less, 87 males and 61 females with acute otitis media were enrolled in a current study. Swab from ear discharges were collected and cultured. The bacterial isolates were identified and the antibiotic susceptibility pattern for S. pneumoniae isolates was tested. Results: Among the 148 infants studied with acute otitis media, the frequency of the isolated microorganisms from infants with otitis media in male were higher than female and the majority of the infants were bottle feed and who exposed to cigarette smoke at home. S. pneumoniae was comprised the most frequent pathogen (40%) in the selected age, and the antibiotic resistance pattern of 68 S. pneumoniae isolates showed high resistance rate against penicillin, erythromycin and cefalothin. On the other hand, imipenem, vancomycin and chloramphenicol were the most effective drugs against S. pneumoniae isolates. Conclusion: The current study has identified S. pneumoniae as the most causes isolated pathogen in infants at age six months or less with acute otitis media and the majority of bacterial isolates showed a high rate of resistance against antibiotics and the majority of these isolates revealed multi drug resistance phenotype. It has been found that children exposed to passive smoking in the home and who are bottle-fed were at increased risk of acute otitis media . Keywords: Acute otitis media, infants, risk factors, Streptococcus. pneumoniae, multi drug resistance