EPIDEMIOLOGICAL ASSESSMENT OF ANTIMICROBIAL RESISTANCE IN HOSPITAL-ACQUIRED INFECTIONS IN CENTRAL IRAQ

Objective: Antimicrobial Resistance (AMR) of hospital-acquired infections (HAs) poses an urgent risk to patient safety in many countries and is not well characterized, especially in central Iraq. To this end, the following epidemiological assessment explores microbiota compositions, susceptibility patterns and risk-factors arising from tertiary hospitals throughout Baghdad and adjacent areas in 2023–2025 epochs. Method: In a systematic investigation of 8500 clinical samples from patients in an intensive care unit, surgical wards and internal medicine department, we identified that the overall rate of HAIs was 52%, with increasing rates seen in those who were ventilated or had longer lengths of stay. Methods Phylogenetic analysis of the clonal spread of MDR K. pneumoniae ST258-like strains between facilities. Results: The isolates were predominantly Gram-negative (62%, led by Klebsiella pneumoniae (35%), Escherichia coli (22%) and Acinetobacter baumannii (18%)), whereas Gram-positive such as Staphylococcus aureus (15%) and Enterococcus spp. (10%) were notable. Multi-drug resistance (MDR) was common: 73% isolates were MDR, 41% CRE and 52% MRSA. Ampicillin (more than 80%) cefotaxime and ciprofloxacin resistance were also common among Gram-negatives in the key resist profile, and raised concern of last resort therapy failure with 28% colistin resistance. Inappropriate use of antibiotics (70% pre-admission exposure), lack of infection control and noncompliance to hand hygiene rules (adherence 40%) were identified as risk factors. These findings indicate a growing AMR crisis driven by empirical prescribing and poor stewardship. Novelty: In the overburdened hospitals of central Iraq, HAIs require urgent interventions—national surveillance networks; rapid diagnostics; and bundled prevention strategies—to contain these infections and preserve therapeutic options.