Antimicrobial Resistance Trends in Najaf (2023–2025) Study

ANTIMICROBIAL RESISTANCE STUDY

Antimicrobial Resistance: From Antibiotic History to Clinical Surveillance

A Retrospective Analysis of Resistance Trends in Najaf, 2023–2025

Faculty of Pharmacy, University of Kufa | March 2026

Presentation Outline

01

Introduction

The antibiotic revolution & AMR crisis

02

History of Antibiotics

From mouldy bread to modern drugs

03

Classification of Antibiotics

Natural, semi-synthetic & synthetic

04

Study Results

Resistance trends 2023–2025 in Najaf

1.1 INTRODUCTION

The Antibiotic Revolution & AMR Crisis

Greatest medical breakthrough of the 20th century — enabling cancer treatment, organ transplants & surgery

Misuse has caused rapid rise of Antimicrobial Resistance (AMR) — some infections now untreatable

O'Neill Report: 10 million deaths/year from drug-resistant infections predicted by 2050 without action

10 Million

deaths/year by 2050

Source: UK O'Neill Report

Stimulate early-stage natural product drug discovery

1.2 HISTORY OF ANTIBIOTICS

A Brief History of Antibiotics

Most Golden Age antibiotics still in clinical use — but effectiveness is being eroded by AMR

1550 BC

Eber's Papyrus: mouldy bread used as remedy

~1900s

Paul Ehrlich: Salvarsan, first systematic drug screen

1928

Alexander Fleming: Discovery of Penicillin

1940s

Waksman: Streptomycin & Golden Age begins

1945

Dorothy Hodgkin: Beta-lactam structure of penicillin solved

1940s–60s

Golden Age: Majority of current antibiotic classes discovered

1.3 CLASSIFICATION OF ANTIBIOTICS

Types of Antibiotics by Source

2. METHODOLOGY

Study Design & Data Sources

Study Design

Retrospective, laboratory-based observational study | Najaf hospitals & healthcare centers | 2023–2025

Data Source

Institutional antibiogram database | Clinical microbiology lab | Specimens: urine, blood, respiratory, wounds

Study Population

All age groups & hospital units | 1,576 clinically significant bacterial isolates | First isolate per patient per period (CLSI guidelines)

Analysis

GraphPad Prism 10.3.1 | Chi-square test for temporal trends | p < 0.05 = significant

1,576

Total Isolates

3 Years

Study Period

2023–2025

Najaf, Iraq

Ethics: Approved by Faculty of Pharmacy, University of Kufa

3. RESULTS

Annual Distribution of Bacterial Isolates (2023–2025)

E. coli

585 isolates

(37.1%)

K. pneumoniae

305 isolates

(19.4%)

P. aeruginosa

224 isolates

(14.2%)

S. aureus

263 isolates

(16.7%)

Enterococcus spp.

143 isolates

(9.1%)

3. RESULTS &mdash; E. COLI

E. coli Antimicrobial Resistance Trends 2023–2025

Significant!

3. RESULTS — GRAM-NEGATIVE PATHOGENS

Klebsiella pneumoniae & Pseudomonas aeruginosa Resistance

K. pneumoniae

Ceftriaxone

60.0%

65.7%

72.2%

+12.2 pp

Ciprofloxacin

45.3%

52.0%

58.3%

+13.0 pp

Meropenem

13.7%

15.7%

20.4%

+6.7 pp

Carbapenem (meropenem) resistance rising: 13.7% → 20.4% ⚠️

P. aeruginosa

Ceftazidime

35.7%

41.9%

48.8%

+13.1 pp

Meropenem

22.9%

28.4%

36.3%

+13.4 pp

Pip-Tazobactam

27.1%

31.1%

35.0%

+7.9 pp

Meropenem resistance rose +13.4 pp — largest increase in this organism ⚠️

None of the K. pneumoniae or P. aeruginosa changes reached statistical significance (p > 0.05)

3. RESULTS — GRAM-POSITIVE PATHOGENS

S. aureus & Enterococcus spp. Resistance Trends

S. aureus

Cefoxitin (MRSA marker)

31.8% → 35.2% → 40.0%

Clindamycin

28.2% → 31.8% → 37.8%

Vancomycin

0.0% → 0.0% → 1.1%

Excellent activity retained

MRSA prevalence rising: 31.8% → 40.0% over 3 years

Enterococcus spp.

Ampicillin

46.7% → 50.0% → 56.0%

Vancomycin

6.7% → 8.3% → 12.0%

Linezolid

0.0% → 2.1% → 2.0%

Most active agent retained

VRE (vancomycin-resistant Enterococcus) showing gradual upward trend ⚠️

Vancomycin & linezolid remain last-resort options — preservation critical for antimicrobial stewardship

3. RESULTS — MULTIDRUG RESISTANCE

MDR Patterns Among Major Pathogens

Escherichia coli

Ampicillin + Fluoroquinolone + Trimethoprim-sulfamethoxazole

24.3%

Klebsiella pneumoniae

Cephalosporin + Fluoroquinolone + Beta-lactam/BLI

35.4%

Pseudomonas aeruginosa

Ceftazidime + Carbapenem + Piperacillin-tazobactam

35.3%

Staphylococcus aureus

★ HIGHEST

Methicillin + Macrolide + Lincosamide

35.7%

Enterococcus

spp.

Ampicillin + Vancomycin

21.7%

MDR isolates represent a serious clinical burden — combination resistance patterns limit treatment options

3. RESULTS — SUBGROUP ANALYSIS

Resistance: Inpatient vs. Outpatient Settings

Inpatient/ICU settings require targeted antimicrobial stewardship interventions

CONCLUSIONS

Key Findings & Clinical Implications

Key Findings

Clinical Implications

<i>E. coli</i> ciprofloxacin resistance increased significantly: 45% &rarr; 56.7% (p = 0.045)

Ampicillin resistance in <i>E. coli</i> persistently high at ~70&ndash;78%

Carbapenem resistance rising in <i>K. pneumoniae</i> (13.7% &rarr; 20.4%) and <i>P. aeruginosa</i> (22.9% &rarr; 36.3%)

MRSA prevalence increased from 31.8% to 40.0% over 3 years

MDR rates highest in <i>S. aureus</i> (35.7%), <i>K. pneumoniae</i> (35.4%), and <i>P. aeruginosa</i> (35.3%)

Restrict empirical fluoroquinolone use for <i>E. coli</i> infections in this region

Monitor carbapenem resistance &mdash; escalating rates threaten last-resort therapy

Implement targeted Antimicrobial Stewardship Programs, especially in inpatient/ICU settings

Vancomycin & Linezolid remain effective last-resort agents &mdash; stewardship essential to preserve them

ANTIMICROBIAL RESISTANCE STUDY | UNIVERSITY OF KUFA

Thank You

Faculty of Pharmacy, University of Kufa

Najaf, Iraq | March 2026

Questions?

Data source: Institutional antibiogram database, Najaf 2023–2025