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Life sciences · Journal article
BMC Infectious Diseases · November 3, 2026
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Abstract Background Antimicrobial resistance (AMR) is a growing global health concern that complicates the treatment of infectious diseases. In Pakistan, the burden of AMR is particularly pronounced due to factors such as overuse of antibiotics, limited surveillance, and weak regulatory frameworks. This study aimed to analyze antimicrobial susceptibility trends from a multi-site tertiary care teaching hospital and provide a rationale for decision-making of empirical treatment. Methods A retrospective analysis was conducted using culture and sensitivity data from the Central Microbiology Laboratory of Dr. Ziauddin Group of Hospitals from January 2021 to December 2023. The study included bacterial isolates from inpatient and outpatient settings. Antibiotic susceptibility testing followed Clinical and Laboratory Standards Institute (CLSI) standards. Data from cultures was analyzed to assess annual resistance trends for common Gram-positive and Gram-negative pathogens. Results A total of 30,309 culture-positive bacterial isolates were analyzed over the three-year study period. Among Gram-negative organisms, E. coli exhibited high resistance to ciprofloxacin, although resistance declined from 80% in 2021 to 62% in 2023. Klebsiella spp. showed an increase in amikacin resistance from 27% in 2021 to 53% in 2023. Acinetobacter spp. demonstrated persistently high resistance to multiple antimicrobial agents, including carbapenems, while colistin resistance remained low. Among Gram-positive organisms, substantial resistance was observed to several commonly used antimicrobial agents, whereas vancomycin, teicoplanin, and linezolid retained good activity against S. aureus. Overall, the resistance patterns emphasize the need for locally informed antimicrobial stewardship and continued surveillance. Conclusion The study reveals local susceptibility patterns in both Gram-positive and Gram-negative pathogens, in inpatient and outpatient settings, emphasizing the urgent need for enhanced AMR surveillance, judicious antibiotic use, and targeted infection control strategies. These findings provide a critical evidence base for developing data-driven policies to combat AMR in tertiary care settings in Pakistan. Clinical trial number Not applicable