Gram-negative bacteria dominate acute appendicitis infections, impacting antibiotic selection.

• E. coli is the most common isolate (71.43%) and shows high resistance to amoxicillin (94.29%).
• Carbapenems and amikacin demonstrate excellent efficacy against key pathogens.

Piperacillin-tazobactam is a strong first-line option, with carbapenems reserved for severe cases or resistant infections.

• Ongoing local resistance monitoring is crucial for tailoring effective antibiotic protocols.