Antimicrobial Resistance in Healthcare Institutions of Nineveh Province

الملخص

Background: Resistance to antimicrobials (AMR) represents a global threat, attenuating the efficacy of modern medicines. In war regions such as Nineveh province, Iraq, AMR is increased by damaged healthcare infrastructure, population displacement, and undermined infection control and surveillance systems.

Objectives: This study aims to assess the prevalence and patterns of antimicrobial resistance among essential bacterial pathogens isolated from different biological samples within healthcare facilities in Nineveh province. 

Materials and Methods: A retrospective descriptive analysis was done on antimicrobial susceptibility tests that were collected from four major hospitals in Nineveh province. The dataset included information from 8200 clinical bacterial isolates tested routinely for antimicrobial susceptibility by using the disk diffusion method conducted between August 2024 and July 2025. Data were analyzed to determine the susceptibility pictures of common microorganisms. Resistance patterns were categorized by antibiotic class with a specific  focus on resistance to last-line antibiotics.

Results: The study showed high rates of resistance to many classes of antibiotics among bacterial isolates. Resistance to commonly prescribed agents was high: resistance to ceftriaxone and to ciprofloxacin was identified in 4300 of 5900 isolates (72.9%) and in 4900 of 8200 isolates (59.8%) respectively. Resistance to carbapenems, which are mainly used for combating Gram-negative infections was noticed at significant levels with 1700 of 5100 isolates (17.6%) resistant to meropenem. Isolates resistant to methicillin were 1899 of 2300 (82.6%) indicating a high prevalence methicillin-resistant bacteria. Finally, resistance to the last-line antibiotic such as polymyxins was also evident, with colistin resistance seen in 500 of 2100 isolates (23.8%).

Conclusion: The increased level of resistance to antibiotics in Nineveh’s healthcare facilities shows a critical clinical and public health crisis. The patterns that are found may be due to misuse of first- and last-line antibiotics, inadequate prescribing procedures, and challenges in maintaining Infection Prevention and Control (IPC) requirements in post war areas. This necessitates the application of specific measures including strong AMR surveillance, focused programs for antibiotic stewardship, and restarted the important steps of infection prevention measures to preserve the effectiveness of remaining antibiotics and safeguard patient health across the province.