Uncomplicated Cystitis in Female Patients in Erbil City: What is the best antibiotic according to culture and sensitivity?

Abstract
Urinary tract infections, especially cystitis, are the second most prevalent cause of antibiotic prescriptions. Most urinary tract infections in women are acute uncomplicated cystitis caused by Escherichia coli (E. coli). This study aimed to assess the bacterial profile of uncomplicated cystitis and their antimicrobial susceptibility patterns among clinically suspected women in Erbil city. A prospective clinical study was conducted between January 2023 and April 2025, at Rizgary and Hawler Teaching Hospitals. Midstream urine was obtained from each participant with a suggestive history of cystitis, specimen then cultured on different media, positive culture after that submitted for identification and antibiotic susceptibility profile by Vitek2 system. To carry this study, 322 samples were collected from patients, their ages ranged between 16-55 years. The results showed that most of the infections were recurrent. Although gram positive bacteria isolated in 38% of the sample, E. coli was the commonest uropathogen (48.6%). Resistance to Trimethoprim/Sulfamethoxazole was 37.8 for gram negative and 28.9 for gram positive micro-organisms, followed by Ciprofloxacin 32.6 % and 16.9% for gram negative and gram positive, respectively. The resistance of bacteria against Nitrofurantoin observed 19.3% and 13.3% for gram negative and positive, respectively. Although E. coli is still the predominant bacteria causing cystitis in females in our cohort, other significant bacteria need to be considered, especially gram positive bacteria. The results also observed that the best antibiotic to be used as empiric treatment for simple cystitis was Nitrofurantion.