Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 18 4 2026 08 04 490 498 Safaa Hanna Aka Department of Clinical Analysis, College of Pharmacy, Hawler Medical University, Erbil, Iraq 2026 02 24 2026 07 25 Background and Objectives: Antimicrobial resistance (AMR) poses a critical global health threat, with multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) pathogens increasingly prevalent in healthcare settings. The study aimed to provide a comprehensive analysis of AMR among clinical bacterial isolates, including detailed antibiogram profiling and prevalence of MDR, XDR, and PDR phenotypes, to inform local treatment guidelines and antimicrobial stewardship strategies. Materials and Methods: A retrospective cross-sectional analysis was conducted on 2,945 clinical specimens (blood, wound, sputum, urine, vaginal swabs, and others). Bacterial identification was performed using VITEK 2 automated system. Antimicrobial susceptibility testing was conducted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. MDR, XDR, and PDR classifications were applied. Results: Out of 2,851 major clinical specimens, Gram-negative bacteria predominated (53%), with highest isolation rates from wound, sputum, and urine samples. Gram-positive organisms accounted for 30%, while Candida species represented 10%. Among Gram-negative isolates, 55% were classified as MDR, 15% as XDR, and 2% as PDR. Gram-positive bacteria showed lower resistance rates with 30% MDR, 4% XDR, and no PDR detected. Species-specific analysis revealed that Klebsiella pneumoniae and Acinetobacter baumannii exhibited the highest XDR and PDR rates, with A. baumannii showing 45% XDR and 10% PDR prevalence. Among Gram-positive organisms, MRSA demonstrated 100% MDR prevalence. The most effective antimicrobials against resistant isolates were carbapenems, amikacin, and vancomycin (for Gram-positives). Conclusion: This study demonstrates alarmingly high rates of MDR, XDR, and PDR among clinical bacterial isolates, with Gram-negative bacteria showing significantly greater resistance burden than Gram-positive organisms. https://ijm.tums.ac.ir/index.php/ijm/article/view/6092 https://ijm.tums.ac.ir/index.php/ijm/article/download/6092/1909