Eleven-year trends in epidemiology, determinants, and antimicrobial resistance of major bacterial pathogens in Jordan: a retrospective surveillance study

Antimicrobial resistance (AMR) is a major global health threat, yet longitudinal surveillance data from Jordan remain limited. This retrospective multicenter surveillance study analyzed routinely collected electronic and laboratory records from 21 Jordanian hospitals between 2013 and 2023. Microbiology records were de-duplicated using a first-isolate-per-patient-per-organism-per-year rule. Among 873,124 bacterial isolates, Escherichia coli (65.3%) predominated, followed by Klebsiella pneumoniae (16.9%), Staphylococcus aureus (12.3%), and Pseudomonas aeruginosa (5.5%). E. coli was associated with female sex and community-acquired infection, whereas K. pneumoniae and P. aeruginosa were more common in hospital settings, with K. pneumoniae strongly associated with intensive care. Although overall odds of any resistance declined significantly over time, several clinically important phenotypes increased. Methicillin-resistant S. aureus rose from 60.0% to 75.9%, while carbapenem resistance reached 4.9% in E. coli, 20.4% in K. pneumoniae, and 19.2% in P. aeruginosa by 2023. Fluoroquinolone resistance also increased, and multidrug-resistant P. aeruginosa reached 20.6%. These findings highlight a distinct AMR paradox in Jordan and underscore the need for pathogen-specific empirical therapy, strengthened antimicrobial stewardship and infection prevention, and sustained national surveillance.