A nationwide cross-sectional study of antimicrobial resistance in Palestinian hospitals: insights from 10,000 clinical isolates.

BACKGROUND: Antimicrobial resistance (AMR) is a global health crisis, but its burden is magnified in conflict-affected, resource-limited settings. We present the first national-scale assessment of AMR in Palestinian hospitals, characterizing prevalence patterns and identifying demographic and clinical predictors of multidrug resistance (MDR). METHODS: This cross-sectional study examined 10,007 unique bacterial isolates from thirteen West Bank governmental hospitals (January-December 2023). Bacterial identification and antimicrobial susceptibility testing adhered to Clinical and Laboratory Standards Institute (CLSI) 2022 guidelines. Multidrug-resistant (MDR) organisms were defined as resistant to ≥ 3 antimicrobial classes. Binary logistic regression identified demographic and clinical predictors of MDR. RESULTS: Of 10,007 bacterial isolates, 36.7% were MDR, with the highest rates observed in Acinetobacter baumannii (76.4%), ESBL-producing Klebsiella pneumoniae (69.2%), and ESBL-producing Escherichia coli (58.3%). Staphylococcus aureus had a 29.5% MDR rate. Elderly patients (≥ 65 years) had the highest MDR (48.4%; adjusted OR 1.85, 95% CI 1.61-2.13, p < 0.001). Hospital-specific MDR rates ranged from 24.0 to 64.4%. CONCLUSIONS: Palestine faces a critical MDR burden, necessitating urgent antibiotic regulation, enhanced stewardship, and standardized diagnostics to mitigate AMR in this and similar conflict-affected settings.