{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:03:25Z","timestamp":1789380205449,"version":"build-2803163510"},"reference-count":45,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background and Aims<\/jats:title>\n \n Antimicrobial resistance (AMR) in\n Enterobacteriaceae<\/jats:italic>\n poses a critical threat to global health, particularly in regions where antibiotic misuse and limited surveillance prevail. Intensive care units (ICUs) act as focal points for resistance emergence and dissemination. This study aimed to evaluate long\u2010term resistance trends among clinically significant\n Enterobacteriaceae<\/jats:italic>\n isolated from two hospitals in North Lebanon (2016\u20132024).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A retrospective analysis was conducted on 14,013\n Enterobacteriaceae<\/jats:italic>\n isolates obtained from Al Monla and Dar Al Shifa hospitals between 2016 and 2024. Identification was achieved using biochemical testing or MALDI\u2010TOF mass spectrometry, and susceptibility testing followed EUCAST standards. No molecular characterization of resistance genes was performed. Data were analyzed using SPSS v23.0, applying Chi\u2010square or Fisher's exact tests (\n p<\/jats:italic>\n \u2009<\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 14,013 isolates,\n Escherichia coli<\/jats:italic>\n (\n E. coli<\/jats:italic>\n ) was predominant (66.4%), followed by\n Klebsiella pneumoniae<\/jats:italic>\n (\n K. pneumoniae<\/jats:italic>\n ) (12.4%),\n Proteus mirabilis<\/jats:italic>\n (\n P. mirabilis<\/jats:italic>\n ) (5.5%), and\n Enterobacter cloacae<\/jats:italic>\n (\n E. cloacae<\/jats:italic>\n ) (3.7%). Overall, \u03b2\u2010lactam resistance remained widespread across species. In\n E. coli<\/jats:italic>\n , carbapenem non\u2010susceptibility increased from 2.7% to 4.8% (\n p<\/jats:italic>\n \u2009<\u20090.001).\n P. mirabilis<\/jats:italic>\n and\n E. cloacae<\/jats:italic>\n exhibited significant increases in ESBL production (\n p<\/jats:italic>\n \u2009=\u20090.006 and\n p<\/jats:italic>\n \u2009=\u20090.007, respectively).\n K. pneumoniae<\/jats:italic>\n showed fluctuating resistance trends with a mild decline in carbapenem resistance (\n p<\/jats:italic>\n \u2009=\u20090.029). ICU isolates demonstrated higher ESBL and MDR rates than non\u2010ICU isolates (\n p<\/jats:italic>\n \u2009<\u20090.01), and hospital\u2010acquired infections showed significantly higher resistance across most drug classes compared to community\u2010acquired cases (\n p<\/jats:italic>\n \u2009<\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Over the 9\u2010year study period, Enterobacteriaceae isolates in North Lebanon demonstrated persistently high \u03b2\u2010lactam resistance and increasing carbapenem non\u2010susceptibility, particularly in\n E. coli<\/jats:italic>\n . These findings underscore the importance of ongoing AMR surveillance and provide regional data that may support future evidence\u2010based clinical and public health decision\u2010making.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/hsr2.72729","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:59:22Z","timestamp":1782827962000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Enterobacteriaceae Resistance Patterns: A Nine\u2010Year Retrospective Study From North Lebanon"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0051-790X","authenticated-orcid":false,"given":"Mazen","family":"Zaylaa","sequence":"first","affiliation":[{"name":"Faculty of Medicine Beirut Arab University Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya El","family":"Bitar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Beirut Arab University Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Jaafar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Beirut Arab University Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majd","family":"Hammoud","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Beirut Arab University Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiba El","family":"Chakra","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Beirut Arab University Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Rahman","family":"Maaliki","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Beirut Arab University Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah El","family":"Dali","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Beirut Arab University Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Awad","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Beirut Arab University Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmine","family":"Hijazi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Beirut Arab University Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar El","family":"Gharbawy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Beirut Arab University Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Sarraf","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine Monla Hospital Tripoli Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibtihal","family":"Kassam","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine Dar Al Shifa Hospital Tripoli Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diala","family":"Wehbe","sequence":"additional","affiliation":[{"name":"Laboratoire de Math\u00e9matiques et Applications, U. 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Math\u00e9matiques et mod\u00e9lisation, Facult\u00e9 Des Sciences Universit\u00e9 Saint\u2010Joseph Liban Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41396-020-00832-7"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01867-1"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2014.07.010"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2022.12.005"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens12060780"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2015.05.005"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.00174-20"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-015-0061-0"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.00234-20"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10354-018-0676-5"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1110.050162"},{"key":"e_1_2_14_13_1","volume-title":"WHO Bacterial Priority Pathogens List, 2024: Bacterial Pathogens of Public Health Importance, to Guide Research, Development and Strategies to Prevent and Control Antimicrobial Resistance","author":"Organization WH","year":"2024"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2017.07.017"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12101978"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2016.03.010"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.3855\/jidc.17313"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/microbiolres15040135"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-024-09294-0"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000040411"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms8101626"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.00044"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2020.106104"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.5455\/OVJ.2024.v14.i1.53"},{"key":"e_1_2_14_25_1","volume-title":"Antimicrobial Resistance Surveillance in Europe 2023: 2021 Data","author":"European Centre for Disease Prevention and Control","year":"2023"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2305.162034"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S244357"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2507.181938"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-019-0487-5"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1128\/aac.00130-21"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.3904\/kjim.2014.29.1.27"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S292246"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics14030290"},{"key":"e_1_2_14_34_1","doi-asserted-by":"crossref","unstructured":"N.SinghPrevalence of ESBL in Escherichia coli Isolates Among ICU Patients in a Tertiary Care Hospital. 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