Aggregate Antibiogram Data on Staphylococcus aureus Across Sentinel Hospitals in Lebanon: A Call for a Prioritized National AMR Action Plan in a Fragile, Conflict-Affected Setting

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OBJECTIVES: Robust antimicrobial resistance (AMR) monitoring is critical for guiding national control strategies. In Lebanon, a fragile, resource-strained setting with a large refugee population, routine AMR surveillance remains fragmented. Staphylococcus aureus (S. aureus) is a major cause of clinical disease, yet recent national susceptibility data are limited. This study provides an updated overview of S. aureus resistance patterns across Lebanon. METHODS: From 2017-2023, aggregated antibiograms were compiled from 13 hospitals, yielding 6959 nonduplicate S. aureus isolates. Clinical microbiology practices, susceptibility methods, and interpretive guidelines were documented. Resistance patterns and temporal trends were evaluated. RESULTS: Methicillin-resistant S. aureus (MRSA) accounted for 37% of isolates, and 9.7% of all isolates were multidrug-resistant. The incidence of S. aureus acquisition per 1000 admissions remained stable, while the incidence of S. aureus bloodstream infections increased significantly. Resistance to several antibiotic classes rose over time. Hospitals in high-high-refugee-density regions reported higher MRSA prevalence and increased resistance across multiple antibiotic classes. CONCLUSION: Rising methicillin resistance and expanding multidrug resistance emphasize the urgent need for strengthened antimicrobial stewardship, improved infection prevention, and establishment of a coordinated national AMR surveillance system.