Antimicrobial resistance in orthopedic infections: a multi-hospital study from Kabul, Afghanistan

Antimicrobial resistance (AMR) represents a critical challenge in orthopedic infections, leading to prolonged morbidity, repeated interventions, and higher treatment failure rates. Data on resistance patterns in Afghanistan remain scarce despite rising global concern. This descriptive cross-sectional study was conducted between January 2024 and January 2025 in four health centers in Kabul, Afghanistan. A total of 167 clinical specimens from suspected orthopedic infections were processed using standard microbiological techniques, and antimicrobial susceptibility testing was performed according to CLSI 2023 guidelines. Of the 167 specimens, 145 (86.8%) yielded positive cultures. Gram-positive bacteria accounted for 54% of isolates, with Staphylococcus aureus (41.9%) as the most frequent, followed by Pseudomonas aeruginosa (13.2%), Escherichia coli (12%), and Enterobacter spp. (7.8%). High resistance rates were observed across multiple antibiotic classes. Ofloxacin resistance was 66.7%, ciprofloxacin 60.7%, and levofloxacin 56.6%. Among β-lactams, amoxicillin resistance reached 93.5%, ceftriaxone 84.6%, and ceftazidime 80.6%. Imipenem resistance was observed in 54.7% of isolates, while Acinetobacter baumannii demonstrated complete resistance (100%) to both imipenem and colistin. Aminoglycoside resistance varied, with amikacin showing 67.0% and gentamicin 51.4%. vancomycin non-susceptibility was 36.7% in S. aureus and 85.7% in S. epidermidis, while linezolid retained strong efficacy with only 15.4% overall resistance. Gram-negative isolates exhibited higher resistance rates than Gram-positive organisms, particularly against β-lactam antibiotics and colistin. The study demonstrates high antimicrobial resistance among orthopedic pathogens in Kabul, Afghanistan, including reduced susceptibility to several commonly used and last-line agents. These findings highlight the urgent need for antimicrobial stewardship programs and national surveillance initiatives, improved diagnostic capacity, and stricter regulation of antibiotic use to mitigate further escalation of resistance in practice.