The Burden of Antimicrobial Resistance in Iraq: An Analysis from 2021

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Background By 2050, antimicrobial resistance (AMR) is projected to become a leading cause of death globally, potentially surpassing cancer. Low- and middle-income countries are particularly vulnerable due to fragile health systems, instability, and economic constraints. Objective This study assessed the burden of AMR in Iraq, identifying the principal infectious syndromes and pathogens contributing to mortality and disability-adjusted life years (DALYs) using Global Burden of Disease data. Results In 2021, the leading infectious causes of death in Iraq were bloodstream infections (BSIs), lower respiratory infections (LRIs), peritoneal and abdominal infections, tuberculosis, and urinary tract infections (UTIs), including pyelonephritis. AMR contributed 63.9%, 55%, 58%, 6.9%, and 62.5% of these deaths, respectively. The syndromes responsible for DALYs were BSIs, LRIs, upper respiratory tract infections, diarrhoeal diseases, and peritoneal and abdominal infections; AMR accounted for 60%, 55%, 0%, 12.5%, and 58.9% of DALYs, respectively. Conclusion The principal pathogens associated with deaths were Streptococcus pneumoniae (12.9%), Staphylococcus aureus (12.4%) , Klebsiella pneumoniae (9.9%) , Acinetobacter baumannii (8.1%) , and Pseudomonas aeruginosa (7.2%). Mortality rates exceeded those of the North Africa and Middle East region NAME for most syndromes, notably UTIs and pyelonephritis. Conclusion AMR represents a substantial burden on mortality and disability in Iraq with the BSI and LRIs were reported at the highest. Coordinated national interventions are required in Iraq, including strengthened diagnostics, workforce training, public awareness, and regulatory enforcement.