A systematic review of antimicrobial resistance among WHO Bacterial Priority Pathogens in Syria (2015-2025)
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Objectives: Antimicrobial resistance (AMR) is an urgent public health threat, but empirical data from Syria remain limited after prolonged conflict-related disruption of healthcare, laboratory, and surveillance systems. We aimed to synthesize available evidence on AMR in Syria.
Methods: We searched PubMed, EMBASE, and Google Scholar for English- or Arabic-language studies from 2015 to 2025 reporting AMR among WHO Bacterial Priority Pathogen List organisms from clinical or screening samples in Syria. Two reviewers independently screened records and extracted study, specimen, organism, susceptibility testing, and resistance data. Findings were synthesized narratively and summarized using study-level medians and interquartile ranges.
Results: Of 203 records identified, 22 studies were included, representing 6,367 samples. Studies were largely hospital-based and concentrated in Damascus, Aleppo, and Lattakia. Third-generation cephalosporin resistance was high among Enterobacterales, including E. coli 83.6% (IQR 71.2-91.6), K. pneumoniae 96.3% (IQR 80.5-100.0), and Enterobacter spp. 90.5% (IQR 56.3-93.5). Median carbapenem resistance in A. baumannii was 79.4% (IQR 51.3-91.7). Fluoroquinolone resistance was common across Gram-negative pathogens. Methicillin resistance among S. aureus was 70.5% (IQR 68.2-72.8).
Conclusion: Syrian AMR data remain sparse and geographically uneven, but available evidence suggests substantial resistance. Standardized national surveillance, microbiology capacity, local antibiograms, and context-specific empiric treatment guidelines are urgently needed.
Methods: We searched PubMed, EMBASE, and Google Scholar for English- or Arabic-language studies from 2015 to 2025 reporting AMR among WHO Bacterial Priority Pathogen List organisms from clinical or screening samples in Syria. Two reviewers independently screened records and extracted study, specimen, organism, susceptibility testing, and resistance data. Findings were synthesized narratively and summarized using study-level medians and interquartile ranges.
Results: Of 203 records identified, 22 studies were included, representing 6,367 samples. Studies were largely hospital-based and concentrated in Damascus, Aleppo, and Lattakia. Third-generation cephalosporin resistance was high among Enterobacterales, including E. coli 83.6% (IQR 71.2-91.6), K. pneumoniae 96.3% (IQR 80.5-100.0), and Enterobacter spp. 90.5% (IQR 56.3-93.5). Median carbapenem resistance in A. baumannii was 79.4% (IQR 51.3-91.7). Fluoroquinolone resistance was common across Gram-negative pathogens. Methicillin resistance among S. aureus was 70.5% (IQR 68.2-72.8).
Conclusion: Syrian AMR data remain sparse and geographically uneven, but available evidence suggests substantial resistance. Standardized national surveillance, microbiology capacity, local antibiograms, and context-specific empiric treatment guidelines are urgently needed.
Date Acceptance
2026-08-15
Citation
International Journal of Infectious Diseases
ISSN
1201-9712
Publisher
Elsevier
Journal / Book Title
International Journal of Infectious Diseases
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
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Publication Status
Accepted