Related Experiment Video
Updated: May 28, 2026
Isolation and Identification of Waterborne Antibiotic-Resistant Bacteria and Molecular Characterization of their Antibiotic Resistance Genes
Published on: March 3, 2023
Extensively Drug-Resistant (XDR) and Pandrug-Resistant (PDR) Acinetobacter baumannii as Sentinel Indicators of
Sarah Ahmed Hasan1, Ali Hasan Mohamed1, Gulbahar F Karim1
1Department of Basic Sciences, College of Nursing, University of Kirkuk, Kirkuk 36001, Iraq.
Abstract:
Antimicrobial resistance (AMR) is one of the most significant threats to healthcare systems, particularly in low- and middle-income nations where infection prevention and control, antimicrobial stewardship, and laboratory surveillance might not be optimal. Acinetobacter baumannii is a high-risk nosocomial pathogen that has a strong capacity to develop extreme resistance phenotypes. Still, the degree to which extensively drug-resistant (XDR) and pandrug-resistant (PDR) phenotypes reflect the cumulative impact of antimicrobial pressure at unit and system levels in Iraqi hospitals is not fully described. This was a cross-sectional surveillance study that was a laboratory-based investigation done in public hospitals in the Governorate of Kirkuk between January 2024 and January 2025. The BD Phoenix system identified 80 non-duplicate A. baumannii isolates that were obtained in high-risk hospital units. The interpretation of antimicrobial susceptibility testing was done according to CLSI guidelines. Internationally recognized definitions were adjusted to local therapeutic availability to classify isolates as XDR or PDR. Unadjusted odds ratios and Fisher's exact test were used to assess the associations between the PDR phenotype and the chosen clinical or unit-level variables. Among the 80 isolates, 60 (75%) were XDR and 20 (25%) were PDR. Burn units and wound-related infections were disproportionately represented by PDR isolates. There were significant associations between the PDR phenotype and burn unit admission, wound infection, exposure to invasive devices, long hospitalization (greater than 14 days), and previous exposure to broad-spectrum antibiotics. ICU admission and respiratory infection were not significantly related. Cefepime had in vitro activity only in a subset of XDR isolates. Extreme resistance phenotypes can be used as convenient sentinel measures of cumulative antimicrobial pressure and system-level stress in resource-limited environments. There is an urgent need to strengthen infection prevention and control, antimicrobial stewardship, and laboratory surveillance to preserve the remaining therapeutic options.
Insights
Antimicrobial resistance in Acinetobacter baumannii is a major threat. Extensively drug-resistant and pandrug-resistant strains were found in Iraqi hospitals, highlighting the urgent need for better infection control and stewardship.
Area of Science:
- * Medical Microbiology
- * Infectious Diseases
- * Public Health
Background:
- * Antimicrobial resistance (AMR) poses a significant global health threat, especially in resource-limited settings.
- * Acinetobacter baumannii is a critical nosocomial pathogen known for developing extreme drug resistance.
- * The extent of extensively drug-resistant (XDR) and pandrug-resistant (PDR) A. baumannii in Iraqi hospitals remains under-described.
Purpose of the Study:
- * To investigate the prevalence of XDR and PDR Acinetobacter baumannii.
- * To identify risk factors associated with the PDR phenotype in Iraqi hospitals.
- * To assess the impact of antimicrobial pressure on resistance patterns.
Main Methods:
- * A cross-sectional, laboratory-based surveillance study was conducted in Kirkuk, Iraq (January 2024 - January 2025).
- * 80 non-duplicate A. baumannii isolates from high-risk hospital units were analyzed using the BD Phoenix system.
- * Antimicrobial susceptibility testing followed CLSI guidelines, with XDR/PDR classification adjusted for local availability.
Main Results:
- * Of 80 A. baumannii isolates, 75% were XDR and 25% were PDR.
- * PDR isolates were disproportionately linked to burn units and wound infections.
- * Significant associations were found between PDR and burn unit admission, wound infections, invasive devices, prolonged hospitalization (>14 days), and prior broad-spectrum antibiotic exposure.
Conclusions:
- * Extreme antimicrobial resistance phenotypes serve as indicators of cumulative antimicrobial pressure in resource-limited environments.
- * Urgent strengthening of infection prevention and control, antimicrobial stewardship, and laboratory surveillance is crucial.
- * Preserving remaining therapeutic options requires immediate intervention and improved healthcare system strategies.
Related Concept Videos
01:25Mechanism of Antibiotic Resistance in MRSA
01:25Clinical Significance of Antibiotic Resistance
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the progression...
01:30Development of Antibiotic Resistance
01:31Defense Against Bacterial Pathogens
Phagocytes
Phagocytes are the frontline soldiers of the immune system. They include neutrophils and macrophages. Neutrophils are the most abundant type of white blood cell and are quickly mobilized to the site of infection. Macrophages are larger cells that patrol...