{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:30:35Z","timestamp":1788363035853,"version":"build-2803163510"},"reference-count":25,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>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\u2019s 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.<\/jats:p>","DOI":"10.3390\/microorganisms14050996","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:46:26Z","timestamp":1777538786000},"page":"996","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Extensively Drug-Resistant (XDR) and Pandrug-Resistant (PDR) Acinetobacter baumannii as Sentinel Indicators of Cumulative System-Level Antimicrobial Pressure in Iraqi Burn and High-Risk Hospital Units"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6163-2747","authenticated-orcid":false,"given":"Sarah Ahmed","family":"Hasan","sequence":"first","affiliation":[{"name":"Department of Basic Sciences, College of Nursing, University of Kirkuk, Kirkuk 36001, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0027-121X","authenticated-orcid":false,"given":"Ali Hasan","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Basic Sciences, College of Nursing, University of Kirkuk, Kirkuk 36001, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3537-2974","authenticated-orcid":false,"given":"Gulbahar F.","family":"Karim","sequence":"additional","affiliation":[{"name":"Department of Basic Sciences, College of Nursing, University of Kirkuk, Kirkuk 36001, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Yehya, A., Ezzeddine, Z., Chakkour, M., Dhaini, Z., Saba, M.S.B., Saba, A.S.B., Nohra, L., Nassar, N.B., Yassine, M., and Bahmad, H.F. (2025). The intricacies of Acinetobacter baumannii: A multifaceted comprehensive review of a multidrug-resistant pathogen and its clinical significance and implications. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1565965"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Shi, J., Cheng, J., Liu, S., Zhu, Y., and Zhu, M. (2024). Acinetobacter baumannii: An evolving and cunning opponent. Front. Microbiol., 15.","DOI":"10.3389\/fmicb.2024.1332108"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"107605","DOI":"10.1016\/j.micpath.2025.107605","article-title":"Acinetobacter baumannii: Global epidemiology, clinical implications, resistance mechanisms, and mitigation strategies","volume":"204","author":"Sharma","year":"2025","journal-title":"Microb. Pathog."},{"key":"ref_4","first-page":"208","article-title":"First Report of Co-Harboring Bleomycin Resistance Gene (bleMBL) and Carbapenemase Resistance Gene (blaNDM-1) Klebsiella Pneumoniae in Iraq with Comparison Study Among the Sensitivity Test, the BD Phoenix CPO Detect Test, and the Rapidec\u00ae Carba NP Test","volume":"16","author":"Hasan","year":"2026","journal-title":"Sib. J. Life Sci. Agric."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"267","DOI":"10.15421\/022439","article-title":"Antibacterial activity of deer musk and Ziziphus spina-christi against carbapenem-resistant Gram-negative bacteria","volume":"15","author":"Hasan","year":"2024","journal-title":"Regul. Mech. Biosyst."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mackieh, R., Al-Bakkar, N., Kfoury, M., Roufayel, R., Sabatier, J.-M., and Fajloun, Z. (2023). Antimicrobial resistance\u2014The need for global solutions. Antibiotics, 12.","DOI":"10.3390\/antibiotics12040650"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kyriakidis, I., Vasileiou, E., Pana, Z.D., and Tragiannidis, A. (2021). Antibiotic resistance mechanisms in Acinetobacter baumannii. Microorganisms, 10.","DOI":"10.3390\/pathogens10030373"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1128\/CMR.00058-07","article-title":"Acinetobacter baumannii: Emergence of a successful pathogen","volume":"21","author":"Peleg","year":"2008","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bridier, A., and Briandet, R. (2022). Microbial Biofilms: Structural Plasticity and Emerging Properties. Microorganisms, 10.","DOI":"10.3390\/microorganisms10010138"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Zhang, J., Jia, P., Zhu, Y., Zhang, G., Xu, Y., and Yang, Q. (2021). Performance evaluation of BD Phoenix NMIC-413 AST panel. Front. Med., 8.","DOI":"10.3389\/fmed.2021.643194"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e01623-23","DOI":"10.1128\/jcm.01623-23","article-title":"Overview of CLSI M100 updates","volume":"63","author":"Schuetz","year":"2025","journal-title":"J. Clin. Microbiol."},{"key":"ref_12","first-page":"e36977","article-title":"EUCAST vs CLSI breakpoint agreement","volume":"15","author":"Gaur","year":"2023","journal-title":"Cureus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"MDR, XDR and PDR definitions","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"22068","DOI":"10.1038\/s41598-024-73258-2","article-title":"Antimicrobial resistance and genetic diversity of A. baumannii","volume":"14","author":"Zhang","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_15","first-page":"4383","article-title":"Emergence of PDR in A. baumannii","volume":"28","author":"Emeka","year":"2024","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_16","first-page":"186","article-title":"Are particle counts better than microbiological sampling to assess air supply cleanliness in operating theatres?","volume":"162","author":"Bak","year":"2025","journal-title":"J. Hosp. Infect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.2147\/IDR.S510193","article-title":"Antibiotic resistance analysis of clinical isolates","volume":"18","author":"Zhao","year":"2025","journal-title":"Infect. Drug Resist."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s40262-022-01137-y","article-title":"Clinical pharmacokinetics of cefepime","volume":"61","author":"Pais","year":"2022","journal-title":"Clin. Pharmacokinet."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Palacios, O.A., Adame-Gallegos, J.R., Rivera-Chavira, B.E., and Nevarez-Moorillon, G.V. (2021). Antibiotics, Multidrug-Resistant Bacteria, and Antibiotic Resistance Genes: Indicators of Contamination in Mangroves?. Antibiotics, 10.","DOI":"10.3390\/antibiotics10091103"},{"key":"ref_20","first-page":"309","article-title":"Antimicrobial resistance: A global multifaceted phenomenon","volume":"109","author":"Prestinaci","year":"2015","journal-title":"Microorganisms"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Merla, C., Mileto, I., Gaiarsa, S., Achille, C., Ghirardello, S., Corbella, M., Baldanti, F., and Cambieri, P. (2023). Surveillance in a Neonatal Intensive Care Unit Allowed the Isolation of a Strain of VIM-Producing Pantoea brenneri. Antibiotics, 12.","DOI":"10.3390\/antibiotics12010098"},{"key":"ref_22","unstructured":"Higgins, P.G., Dammhayn, C., Hackel, M., and Seifert, H. (2021). Global spread of Acinetobacter baumannii. Microorganisms, 9."},{"key":"ref_23","first-page":"291","article-title":"Evaluate the benefit effects of Dodonaea viscosa in kidney of infected rats with Staphylococcus aureus","volume":"13","author":"Majeed","year":"2022","journal-title":"J. Pharm. Negat. Results"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"182","DOI":"10.30699\/ijmm.19.3.182","article-title":"Evaluation of trimethoprim nanoemulsion against Proteus mirabilis","volume":"19","author":"Hasan","year":"2025","journal-title":"Iran. J. Med. Microbiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e25312","DOI":"10.54448\/ijn25312","article-title":"Drug resistant bacteria and antimicrobial activity of medicinal plants","volume":"18","author":"Hasan","year":"2025","journal-title":"Int. J. Nutrology"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/5\/996\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:56:54Z","timestamp":1777539414000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/5\/996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["microorganisms14050996"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14050996","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]}}}