Antimicrobial resistance surveillance of clinical bacterial isolates at Maryamana private hospital, Erbil-Iraq (2023–2025): antibiogram data and multidrug-resistant (MDR)/extensively drug-resistant (XDR)/pandrug-resistant (PDR) classification

Abstract

Background and Objectives: Antimicrobial resistance (AMR) poses a critical global health threat, with multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) pathogens increasingly prevalent in healthcare set- tings. The study aimed to provide a comprehensive analysis of AMR among clinical bacterial isolates, including detailed antibiogram profiling and prevalence of MDR, XDR, and PDR phenotypes, to inform local treatment guidelines and antimi- crobial stewardship strategies.

Materials and Methods: A retrospective cross-sectional analysis was conducted on 2,945 clinical specimens (blood, wound, sputum, urine, vaginal swabs, and others). Bacterial identification was performed using VITEK 2 automated system. Anti- microbial susceptibility testing was conducted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. MDR, XDR, and PDR classifications were applied.

Results: Out of 2,851 major clinical specimens, Gram-negative bacteria predominated (53%), with highest isolation rates from wound, sputum, and urine samples. Gram-positive organisms accounted for 30%, while Candida species represented 10%. Among Gram-negative isolates, 55% were classified as MDR, 15% as XDR, and 2% as PDR. Gram-positive bacteria showed lower resistance rates with 30% MDR, 4% XDR, and no PDR detected. Species-specific analysis revealed that Klebsiella pneumoniae and Acinetobacter baumannii exhibited the highest XDR and PDR rates, with A. baumannii showing 45% XDR and 10% PDR prevalence. Among Gram-positive organisms, MRSA demonstrated 100% MDR prevalence. The most effective antimicrobials against resistant isolates were carbapenems, amikacin, and vancomycin (for Gram-positives).

Conclusion: This study demonstrates alarmingly high rates of MDR, XDR, and PDR among clinical bacterial isolates, with Gram-negative bacteria showing significantly greater resistance burden than Gram-positive organisms.