Antimicrobial Resistance Trends in ICU-acquired Infections after the COVID Epidemic: A 5-year Retrospective Cohort and Comparative Review with MENA Region

Background: Antimicrobial resistance (AR) in hospital-acquired infections (HAIs) poses a significant global health challenge, particularly in intensive care units (ICUs). The COVID-19 pandemic has exacerbated AR trends due to increased antibiotic misuse and strained infection control measures. However, comparative data on pre- and post-pandemic AR trends of Gram-negative pathogens in ICUs of the Middle East and North Africa (MENA) region remain scarce. Methods: This retrospective cohort study was conducted on 472 clinical isolates from 242 ICU patients. Bacterial identification and antibiotic susceptibility testing were performed according to updated standard microbiological protocols (e.g., CLSI guidelines). The distribution of bacterial species, resistance categories (MDR, XDR, PDR), and antibiotic-specific resistance were assessed with temporal comparisons drawn to pre- and post-COVID-19. Results: Klebsiella pneumoniae was the most frequent isolate, followed by Pseudomonas aeruginosa and Escherichia coli. Respiratory specimens dominated and surpassed urinary infections. Overall resistance was highest to ceftriaxone, fluoroquinolones, and carbapenems, while colistin remained the most effective antibiotic. AR rates were high, with 76.9% MDR, 64.8% XDR, and 1.5% PDR isolates. AR prevalence, particularly XDR isolates increased after the onset of the COVID-19 pandemic (>20%). Acinetobacter baumannii consistently exhibited the highest AR (>90% XDR, 100% carbapenem resistance). Conclusion: This study highlights the alarming rise in MDR and XDR pathogens in ICU settings following the COVID-19 pandemic. These findings underscore the urgent need for region-specific surveillance and antibiotic stewardship to guide rational empirical therapy and curb AR in ICU settings. Trial registration: Not applicable.