Antibiotic susceptibility and resistance in Karbala city hospitals, Iraq: a comprehensive monitoring study from 2023

Antimicrobial resistance (AMR) continues to pose a tremendous challenge to healthcare systems worldwide. Our team conducted comprehensive surveillance across six hospitals in Karbala province to assess local resistance patterns. Clinical specimens yielded 8,363 bacterial isolates that were analyzed using the WHONET surveillance program throughout 2023. Results indicated troubling multidrug resistance rates, with approximately 21% of Acinetobacter species and Escherichia coli demonstrating resistance to three or more antibiotic classes. Similarly, 19% of Staphylococcus aureus isolates exhibited multidrug resistance profiles. Beta-lactam antibiotics showed particularly diminished efficacy, with high resistance rates observed against ampicillin (87%), amoxicillin-clavulanate (72%), and first-generation cephalosporins (68%). Carbapenems retained relatively better activity against gram-negative pathogens, with resistance rates of 17-23%, while colistin resistance remained below 10%. For gram-positive infections, vancomycin maintained good efficacy with resistance rates under 5%. These findings provide essential local epidemiological data to inform antimicrobial stewardship initiatives and guide empirical therapy protocols in our region.