Prevalence and Antimicrobial Resistance of Staphylococcus saprophyticus in Urinary Tract Infections: A Cross-Sectional Study from Thi-Qar in Iraq

Abstract

Background: Urinary tract infections (UTIs) are a significant public health concern worldwide. Staphylococcus saprophyticus is the second most common Community-acquired uropathogens, and most frequently infects young women who are sexually active. There is a paucity of epidemiological information concerning southern Iraq.
Objectives: To establish the rate of occurrence of S. saprophyticus among UTI patients at Al-Rifae General Hospital in Thi-Qar Governorate, Iraq, and to analyze the patterns of resistance to antimicrobial drugs among the isolated strains.
Methods: Methods: Between October 2025 and February 2026, this cross-sectional study analyzed 226 midstream urine (MSU) samples from patients with suspected UTIs. The identification of bacterial isolates and biochemical tests was followed by verification with VITEK-2 Compact (bioMérieux). Antimicrobial susceptibility (AST) tests were performed using the Kirby-Bauer disk diffusion method in accordance with the 2023 Clinical and Laboratory Standards Institute (CLSI) M100. Statistical analyses were based on the Chi-square (χ²) tests, 95% Wilson confidence intervals (CIs), and odds ratios (ORs).
Results: Results: An analysis of 226 urine samples led to the confirmation of 20 isolates (8.8%; 95% CI: 5.8%–13.3%) as S. saprophyticus. Infection rates were higher among females (80%) than males (20%) (χ² = 7.20, p = 0.007; OR = 4.0; 95% CI: 1.2–13.4). Rural residents represented 65% of the total cases. The 11–20 years age group had the highest infection rates (40%). Susceptibility to Nitrofurantoin was the highest (70%) and the highest resistance was to the erythromycin group (80%), while susceptibility levels were at 35% for azithromycin, levofloxacin, and ciprofloxacin, and at 50% for ofloxacin.
Conclusion: In Thi-Qar, S. saprophyticus is a significant uropathogen that largely impacts young females living in rural communities. Its high resistance to macrolide and fluoroquinolone classes poses a challenge to antibiotic stewardship in Thi-Qar which necessitates an ongoing assessment of antimicrobial resistance in this community.