Growing patterns of multi-drug resistance in wound infections: a retrospective cross-sectional study from northern Iraq

Despite growing concerns over wound infections, there are limited nationwide studies exploring the distribution of pathogens and their resistance patterns. Considering regional variations in resistance, this single-center study conducted in Iraq aims to investigate the distribution of pathogenic bacteria and their antimicrobial resistance in wound infections. This retrospective cross-sectional study analyzed wound culture data from inpatients in a single center located in Iraq between January and December 2023. Wound specimens were tested for microbial identification and antimicrobial susceptibility. Patient data, including clinical and laboratory information, were obtained from electronic medical records. Patients were classified into Multidrug Resistance (MDR) and non-MDR groups based on susceptibility results. A p-value of <0.05 was considered statistically significant. A total of 195 samples were collected from 145 patients, with 178 (91.2%) showing microbial growth. Among these, 97 (54.5%) were single infections, and 81 (45.5%) were mixed infections. Among Gram-positive isolates, Staphylococcus aureus was the most common isolate present in 29 (16.3%) samples. For Gram-negative isolates, Escherichia coli was identified in 35 (19.7%) samples, and Pseudomonas aeruginosa in 21 (11.8%) samples. Gram-positive isolates showed high resistance rates, particularly to cefixime 12 (92.3%). Among Gram-negative isolates, resistance was highest to rifampin and clindamycin, with 100% resistance noted. A total of 149 (83.7%) isolates were MDR. This study highlights the growing issue of antibiotic resistance, especially in Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The increasing prevalence of MDR necessitates stronger infection control, enhanced antibiotic stewardship, and personalized treatment strategies to improve patient outcomes in healthcare settings across Iraq.