Antimicrobial Resistance Trends in Healthcare-Associated Infections in Lahore: A Tertiary Care Perspective

Abstract

Background: Antimicrobial resistance (AMR) is a critical global health concern, particularly in healthcare-associated infections (HCAIs) where multidrug-resistant (MDR) pathogens compromise treatment efficacy and increase mortality. Tertiary care hospitals in low-resource settings like Lahore face growing threats due to poor antimicrobial stewardship, limited surveillance, and the emergence of resistance to last-line antibiotics. Objective: This study aimed to assess the prevalence, resistance profiles, and molecular mechanisms of AMR in HCAI pathogens in tertiary care hospitals in Lahore, focusing on high-risk Gram-negative organisms and their clinical impact in ICU settings. Methods: A retrospective observational study was conducted via systematic review of 53 peer-reviewed articles and regional surveillance reports published between 2014 and 2023. Inclusion criteria included studies from Lahore reporting resistance profiles of nosocomial pathogens; community-acquired infections and non-English sources were excluded. Data were extracted on pathogen distribution, resistance rates, and associated risk factors. Ethical compliance with the Declaration of Helsinki was ensured through exclusive use of anonymized, published data. Descriptive statistics were computed using SPSS v27. Results: E. coli (24%), Acinetobacter spp. (23%), and P. aeruginosa (19%) were the most prevalent pathogens. Carbapenem resistance reached 98% in Acinetobacter and 89% in Pseudomonas, while colistin retained 93–100% activity. Extended hospital stays and prior antibiotic exposure were associated with 85.5% of MDR cases. Only 38.1% of hospitals adhered to stewardship guidelines. Conclusion: MDR pathogens in Lahore’s tertiary care hospitals present a significant challenge to patient safety and treatment efficacy. Strengthening antimicrobial stewardship, infection control, and molecular surveillance is urgently needed to curb the clinical impact of AMR.