Antimicrobial resistance in Palestine: Emerging hotspots and trends from a 4-year hospital-based study

Objectives We aimed to conduct a 4-year retrospective analysis of antimicrobial resistance (AMR) trends and infection hotspots within a major referral hospital in West Bank. Methods A total of 18,802 bacterial isolates from 15,147 patients from the Palestine Medical Complex were assessed from January 2020 to December 2023. Data were analyzed to yield organism prevalence, trends of resistance, and ward-level infection burdens. Results Resistant isolates increased from 31.9% in 2020 to 37.7% in 2023, driven primarily by extended-spectrum β-lactamase–producing Escherichia coli and carbapenem-resistant Enterobacteriaceae. The emergency department, intensive care unit, and surgical unit were identified as primary hotspots for AMR. Patients aged 60-75 years showed significant infection risks, necessitating age-specific infection control management. Time trend analysis revealed seasonal peaks of AMR and a significant surge of carbapenem-resistant Acinetobacter baumanii cases during the 2022 COVID-19 pandemic, suggesting a syndemic interaction. Conclusion The escalating AMR threat signifies the importance of surveillance and warrants an urgent, targeted AMR intervention. Implementation of ward-specific antimicrobial stewardship, demographic-targeted infection control, and regional data-sharing frameworks are critical to mitigating the spread of AMR in conflict-affected and fragile health systems.