National surveillance of antimicrobial resistance in Iran using IAMR software: A hospital-based study

Antimicrobial resistance (AMR) is a growing global public health concern that requires standardized and context-specific surveillance systems to inform antimicrobial stewardship and clinical decision-making.

This study aimed to evaluate AMR patterns among inpatient and outpatient populations in a tertiary teaching hospital in central Iran and to assess the performance of the Iranian Antimicrobial Resistance Management (IAMR) system in generating stratified surveillance data.

A cross-sectional study was conducted from September 2023 to July 2024 using routine clinical specimens. Bacterial isolates were identified using standard microbiological methods, and antimicrobial susceptibility testing was performed according to CLSI guidelines. The IAMR system was used for data management, including data cleaning, duplicate removal, and stratification by clinical setting and hospital wards, enabling the generation of antibiograms.

Gram-negative bacteria were predominant in both inpatient and outpatient groups, with Escherichia coli accounting for more than 50% of isolates. Resistance rates were higher among inpatients, particularly to third-generation cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole. Intensive care units showed a higher prevalence of multidrug-resistant Klebsiella spp. and Pseudomonas aeruginosa. Outpatient isolates exhibited comparatively higher susceptibility rates. The IAMR system facilitated the identification of resistance patterns across different clinical settings.

AMR patterns differed between inpatient and outpatient settings. The use of a structured surveillance system such as IAMR supports the analysis of routine laboratory data and may assist in informing antimicrobial stewardship strategies and alignment with national and international surveillance programs such as GLASS.