Background: Hospital-acquired infections (HAIs) caused by multidrug resistant (MDR) bacteria are a major public health problem especially in resource-limited settings. Local data on antimicrobial resistance (AMR) are crucial to inform empirical therapy and infection prevention. Objectives: To identify bacterial pathogens causing HAIs, determine their AMR profiles and independent risk factors for MDR infections in a tertiary hospital in Erbil City, Iraq. Materials and Methods: A cross-sectional study was done at Hawler Teaching Hospital between January and June 2026. Standard microbiological methods were used to analyse 200 clinical specimens from patients with HAIs (≥48 hr after admission). Antimicrobial susceptibility testing was performed according to CLSI 2024 guidelines. MDR was defined as nonsusceptibility to at least one agent in three or more antimicrobial classes. Multivariate logistic regression was used to assess independent risk factors. Results: Bacterial growth was obtained in 149 of 200 specimens (74.5%). The major pathogens were Escherichia coli (31.5%), Klebsiella pneumoniae (23.5%), Staphylococcus aureus (21.5%), Pseudomonas aeruginosa (14.1%) and Acinetobacter baumannii (6.1%). In total, 69.1% of the isolates were MDR, with the highest rates in K. pneumoniae (80.0%) and A. baumannii (77.8%). Independent predictors of MDR infection were previous antibiotic use (AOR=4.45), ICU admission (AOR=3.92), and hospitalization >7 days (AOR=3.10). Conclusion: This study documented a significant burden of MDR-HAIs in Erbil City and determined modifiable clinical risk factors. The findings provide evidence to support antimicrobial stewardship, infection prevention and AMR surveillance in Iraqi healthcare settings.