Antimicrobial resistance (AMR) poses a serious and growing threat to global public health, undermining decades of progress in infectious disease control. Antibiotic stewardship (ABS) — aimed at optimizing antimicrobial use across human, animal, and environmental health — has become central to this response. This article presents a scoping review of 203 academic and grey literature sources to examine the global governance architecture of ABS. Anchored in a One Health lens and drawing on multi-level and polycentric governance theory, the review maps key actors, institutional arrangements, and policy mechanisms shaping international stewardship efforts. Despite growing consensus, stewardship governance remains fragmented, underfunded, and marked by stark disparities between high-income and low- and middle-income countries. To address these challenges, the paper proposes an original Integrated Polycentric Glocal Governance Framework (IPGF) and applies it to two case studies in the Middle East and North Africa (MENA) region. This model emphasizes decentralized coordination, stakeholder inclusivity, and adaptive learning to better align global norms with local realities. The findings call for structural reform and innovative governance approaches to strengthen global antibiotic stewardship and mitigate the accelerating AMR crisis.

Background: Cancer patients receiving chemotherapy are facing a higher risk of bloodstream infection (BSI) because of febrile neutropenia. In febrile neutropenia, rational use of antibiotics is important for reducing morbidity and preventing the emergence of drug-resistant bacteria. There is a lack of data on BSI epidemiology in Libyan pediatric cancer patients. We conducted this study to determine the frequency and type of isolated microorganisms, as well as the profile of antibiotic resistance. Material and methods: This was a three-year retrospective study, 2021-2023. We recorded data on all blood cultures taken from pediatric cancer patients treated at the National Cancer Institute, Misurata, between January 2021 and December 2023. We analyzed the microbiological profile and sensitivity pattern. Results: The pediatric oncology department sent 615 blood culture samples (168 central venous catheters, 447 peripheral veins) to patients admitted with febrile neutropenia. There were 106/615 (17.6%) positive cultures. Gram-positive organisms were the most commonly isolated bacteria, accounting for 58.2%, and Gram-negative organisms accounted for 37.8%. Staphylococcus aureus 56.6% was the most common Gram-positive, and Pseudomonas areogenosa was the most common among Gram-negative bacterium (24/38, 63.15%), followed by Klebsiella pneumonia (13/38, 34.2%). A higher proportion of carbapenem resistance isolates were seen in Klebsiella pneumonia (10/13, 77%). Conclusion: The prompt detection of microbial isolates in cancer patients is fundamental to developing an appropriate early treatment policy. The emergence of antibiotic-resistant bacteria is alarming for the use of antibiotics and for institutional infection control protocols.

Background and Aims: Carbapenem-resistant Acinetobacter baumannii (CRAB) is an opportunistic Gram-negative pathogen that plays a significant role in healthcare-associated infections, leading to severe health complications. While numerous studies have focused on the antibiotic-resistance epidemiology of A. baumannii, fewer have investigated its molecular virulence epidemiology. This study aimed to explore CRAB virulence genes, their biofilm-forming capabilities, and the correlation between biofilm formation and both biofilm-associated virulence genes and carbapenemase-encoding resistance genes. Materials and Methods: A total of 110 CRAB clinical isolates were collected from two hospitals in Jordan between 2018 and 2019. These isolates were screened for at least seven virulence genes using polymerase chain reaction, and biofilm formation ability was evaluated using the microtiter plate method. Results: the prevalence of the bap, OmpA, surA, PLD, paaE, basD, and traT virulence genes was 99.1%, 98.2%, 98.2%, 95.5%, 89.1%, 86.4%, and 8.2%, respectively. Overall, 86.4% of the isolates demonstrated biofilm-forming ability, classified as weak (28.2%), moderate (36.4%) and strong (21.8%). No statistically significant correlation was observed between biofilm production and the presence of bap, OmpA, or the carbapenemase-encoding gene (VIM gene). However, a significant relationship was identified between the carbapenemase-encoding gene (OXA-23 gene) and biofilm production. Conclusions: CRAB infections pose a substantial threat in healthcare settings. This study underscores the critical need to enhance infection control measures in healthcare facilities to prevent CRAB outbreaks. To our knowledge, this is the first study in Jordan to examine the prevalence of virulence genes among clinical CRAB isolates.

Acinetobacter baumannii (A. baumannii) is a bacterium causing infections in hospitals, especially in intensive care units (ICUs). This bacterium persists in hospital environments and quickly becomes resistant to medicines. This review details its behavior, spread, and control in hospital care areas, focusing on environmental monitoring and One Health strategies to stop antimicrobial resistance (AMR). We explain methods to sample and grow bacteria for identification, using quantitative PCR and whole-genome sequencing for rapid detection. We discuss data management frameworks and bioinformatics pipelines that help analyze data and visualize bacterial spread. Control measures include careful cleaning, environmental decontamination machines, and antimicrobial stewardship programs. The One Health perspective emphasizes the connection between humans, animals, and nature in controlling bacteria. Challenges include limited lab space, varied data collection methods, and need for new testing approaches. This report suggests future research in metagenomic surveillance, machine learning-driven risk modeling, and pangenome-guided drug discovery. By integrating laboratory, clinical, and environmental science, this report provides a comprehensive plan to control A. baumannii in ICUs and address antimicrobial resistance.

Background and Aims: Pediatric patients are considered a special patient population for medication use. The study aims to assess the role of clinical pharmacists in the appropriate use of antibiotics among inpatient pediatrics and to evaluate some infection-related outcomes. Method: The study was designed as an interventional randomized controlled trial, where 132 patients from the internal pediatric ward in a main hospital in Jordan were included. Pediatric patients were divided into three age groups. Each age group was sub-grouped into control and intervention groups. All patients` caregivers were interviewed, and patients’ medical files were reviewed. All antibiotic-related problems and their side effects were documented. Recommendations to solve these problems were made to the treating physician or administering nurse in the intervention group. Follow-up data were collected for each group. Results: After a review of cases, the most frequent antibiotics-related problems found were administration errors. The antibiotic-related problems were reduced in the intervention group by 70.67% with a high response rate from the medical team. The mean length of stay in the control group and implemented intervention group was 8.02 days and 6.7 days respectively, with a significant difference (p=0.039). The incidence of side effects associated with the inappropriate use of antibiotics was also reduced. Conclusions: The clinical pharmacist interventions in our study resulted in enhancing the appropriate use of antibiotics among inpatients pediatrics and decreasing the mean length of stay as well as the incidence of side effects associated with the inappropriate use of antibiotics.

Background: Antibiotic resistance is a serious global concern. It contributes to increasing the morbidity and mortality rates associated with infections. In the Middle East and countries such as Jordan resistance levels are escalating due to practices such as self-medication, irrational prescribing, and lack of public awareness. Assessing and establishing the awareness towards resistance can inform the way forward. Aims: The study aimed to assess the awareness of antibiotic resistance in Jordan and to find if certain factors were related to the level of awareness. Materials and Methods: A cross-sectional study utilizing the WHO multi-country public awareness questionnaire was used to survey people in Jordan using a convenience sampling method. The survey was distributed through online platforms. Several factors were considered (gender, urbanizations, education, and working in health sector). The association was studied using Chi-squared and Fischer’s exact tests. Results: A total of 469 participants completed the questionnaire. Several misconceptions were detected. For example, 85.1% were unable to correctly define antibiotic resistance and 45.6% believed colds could be treated with antibiotics. Working in the health sector and educational level affected the responses of the participants the most regarding the knowledge and seriousness of antibiotic resistance. Gender and urbanization were less significant. Conclusion: Educational campaigns targeting which conditions require antibiotics and further studies are needed to enhance public awareness and to correct misconceptions.

Background: There is an alarming increase in multi-drug resistant (MDR) bacterial infections worldwide. The Mediterranean region, including Jordan, reports a particularly high prevalence of hospital-acquired MDR infections, especially in Intensive Care Units (ICUs). Aim: To investigate the prevalence, antibiotic susceptibility, risk factors, and resistance genes associated with bacterial infections in ICUs across Jordan. Methodology: A total of 177 bacterial isolates were collected from 12 ICUs across Jordan between September 2019 and April 2022. Patient demographics, isolate characterization, antibiotic susceptibility, and resistance genes were recorded and analyzed. Results: The isolates included Klebsiella (22.6%), Staphylococcus (18.0%), Escherichia (17.5%), Acinetobacter (16.4%), Enterococcus (6.2%), Pseudomonas (6.2%), and others (13.0%). Of all isolates, 41.2% were MDR, 17.5% were extensive drug-resistant (XDR), and 6.8% were pandrug-resistant (PDR). MDR rates were highest in Klebsiella (82%), followed by Acinetobacter (79%), Pseudomonas (63%), Staphylococcus (56%), and Escherichia (51%). High resistance rates were observed for all antibiotics except vancomycin, colistin, linezolid, and teicoplanin (˂10%). Significant associations were found between MDR infections and Gram-negative bacteria, central lines, mechanical ventilation, nasogastric tubes, a history of recurrent infections, previous surgeries, bedridden patients, prophylactic antibiotic use, recent antibiotic exposure in the last two weeks, and elevated white blood cell counts (P˂0.05). MDR infections were also significantly linked to higher rates of complications and death (P˂0.05). The most common resistance genes identified were KPC in K. pneumoniae (28.6%), mecA for Staphylococci (62.5%), CTX-M among E. coli (48.4%), OXA-51 and OXA-23 genes in A. baumannii/spp (100%) and vanA gene for E. faecalis/spp (45.5%). Conclusion: ICUs serve as critical reservoirs for MDR bacterial infections. Implementation of nationwide, evidence-based antibiotic stewardship programs is strongly recommended.

Background: Misuse of antibiotics is a global health challenge that accelerates antibiotic resistance and interferes with effective disease management. This study focuses on determining the prevalence of antibiotic misuse among Jordanian women of reproductive age and examines the sociodemographic factors associated with this behavior. Methods: A cross-sectional approach was adopted, utilizing structured questionnaires to collect data on socioeconomic characteristics, antibiotic usage behaviors, and related factors. A total of 238 participants were recruited; however, only 226 met the eligibility criteria. The data was analyzed using descriptive and multivariate analysis by SPSS 28. Results: The findings indicated a prevalence rate of 25.7% for antibiotic misuse within the study sample (n = 238). There were weak associations between misuse and higher family income and larger family sizes. On the other hand, higher academic level slightly reduced the likelihood of obtaining antibiotics without a prescription. No statistically significant correlations were identified between demographic variables such as age, education, or income and antibiotic misuse. Conclusion: This study found that antibiotic misuse is common among Jordanian women of reproductive age. The findings underscore the need for targeted context sensitive awareness interventions about antibiotic resistance and call for further research into cultural and systemic influences on antibiotic use.

Antibiotic resistance accounts for over 50% of Escherichia coli (E. coli) infections, mediated by extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases, carbapenemase, and other mechanisms. Data on AmpC, carbapenemase, aminoglycosides, and quinolones resistance of E. coli in Jordan are minimal. This study aimed to determine the molecular and phenotypic prevalence of antibiotic-resistant E. coli in Jordan. Methods: 153 E. coli isolates collected from multiple Jordanian hospitals were tested for species identification, antibiotic susceptibility, and resistance genes. Results: 153 E. coli isolates were collected with a mean age of 47.09 ± 25.32. Most samples were collected from the emergency department (29.7%) and urine samples were the major source (82.9%). For AmpC detection, 67 (57.8%) samples were resistant to cefoxitin, 13 (23.2%) were positive for AmpC disk test, all tested samples were negative for CMY-1 gene, while 15 (14.4%) samples were positive for CMY-2 gene. Regarding aminoglycoside resistance, 54 (38 %) strains were resistant to gentamycin, 3 (2.1%) were resistant to amikacin, and 94 (61.4%) samples had aac6’-Ib-cr gene. For fluoroquinolones resistance, 92 (65.7 %) isolates were resistant to ciprofloxacin, 65 (47.1%) were resistant to levofloxacin, and 102 (98%) isolates were positive for the gyrA gene. Finally, 3 (2%) isolates were resistant to imipenem and meropenem, however, carbapenemase genes including KPC, OXA-48, IMP, and VIM genes were negative in all samples. Conclusion: Understanding the molecular and phenotypic characteristics of antibiotic-resistant E. coli will help to guide proper antibiotic therapy and combat microbial resistance in Jordan.