Background: This is the first nationwide assessment of WHO-designated bacterial resistance in Iraq. Aim: To analyse antimicrobial resistance patterns over 4 years in Iraq, based on data from the national surveillance system. Methods: Using the WHO Antimicrobial Resistance Network software, we collected and analysed 238 973 antimicrobial resistance data from the 106 antimicrobial resistance surveillance sites across Iraq, for 2020–2023, from the Iraqi national surveillance system. The data were analysed using SPSS version 26. Results: Resistance to carbapenem by Acinetobacter baumannii increased markedly, reaching 80% in 2023. Resistance to third-generation cephalosporins was notably high among Acinetobacter baumannii (88.5–92%), Escherichia coli (88.0%) and methicillin-resistant Staphylococcus aureus (74.0%). Multidrug resistance and extensively drug-resistant profiles for Acinetobacter spp. and Klebsiella pneumoniae increased, particularly in extensively drug-resistant Acinetobacter spp. (66%). Resistance to last-line reserve antibiotics, such as colistin and tigecycline, increased significantly in 2023, suggesting an increasing threat to the efficacy of these critical agents. Conclusion: These findings indicate that several key pathogens in Iraq have surpassed the critical resistance thresholds, thus limiting the effectiveness of commonly used empirical therapies and narrowing treatment options. Strengthening antimicrobial stewardship and prescription practices is essential to curb resistance and protect the efficacy of treatment regimens.
