Antimicrobial susceptibility of gram-positive and gram-negative bacteria: a 5-year retrospective analysis at a multi-hospital healthcare system in Saudi Arabia

Abstract

Background Studying time-related changes in susceptible pathogens causing healthcare-associated infections (HAIs) is vital in improving local antimicrobial and infection control practices. Objectives Describe susceptibility patterns to several antimicrobials in gram-positive and gram-negative pathogens isolated from patients causing HAIs at three private tertiary care hospitals in Saudi Arabia over a 5-year period. Methods Data on trends of antimicrobial susceptibility among bacteria causing HAIs events in children and adults at three tertiary private hospitals located in Riyadh and Qassim, Saudi Arabia, were collected retrospectively between 2015 and 2019 using the surveillance data datasets. Results Over a 5-year period, 38,624 pathogens caused 17,539 HAI events in 17,566 patients. About 9450 (53.8%) of patients who suffered HAIs were females and the average age was 41.7 ± 14.3 years (78.1% were adults and 21.9% were children). Gram-negative pathogens were 2.3-times more likely to cause HAIs compared to gram-positive bacteria (71.9% vs. 28.1%). The ranking of causative pathogens in decreasing order was: Escherichia coli (38%), Klebsiella species (15.1%), and Staphylococcus aureus (12.6%). Gram-positive isolates were mostly susceptible to linezolid (91.8%) whereas they were resistant to ampicillin (52.6%), cefoxitin (54.2%), and doxycycline (55.9%). Gram-negative isolates were mostly sensitive to tigecycline (95%) whereas they were resistant to cefotaxime (49.5%) and cefixime (59.6%). During the 5 years, there were relatively stable susceptibility patterns to all tested antimicrobials, except for cefotaxime which shown a susceptibility reduction by 41.4%, among Escherichia coli and Klebsiella species. An increase in the susceptibility of Acinetobacter and Enterobacter and Citrobacter species to all studied antimicrobials was observed except for colistin that had a slight sensitivity reduction in 2019 by 4.3% against Acinetobacter species. However, we noted reduced sensitivity of MRSA, CoNS and Enterococcus species to gentamicin; and increased resistance of MRSA to linezolid and vancomycin. Conclusion The observed increase in susceptibility of gram-positive and gram-negative bacteria to studied antimicrobials is important; however, reduced sensitivity of MRSA, CoNS and Enterococcus species to gentamicin; and increased resistance of MRSA to linezolid and vancomycin is a serious threat and calls for effective antimicrobial stewardship programs.

Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis

“…can also affect the quality of care and the rate of ICU-acquired, healthcare-associated infections [ 87 , 88 ]. With observed strains currently being placed on healthcare systems during the upstroke of the SARS-CoV-2 pandemic, guidelines must focus on the maintenance of good knowledge and compliance of infection prevention and control [ 89 ], antimicrobial stewardship [ 90 ], and robust surveillance for healthcare-associated infections and antimicrobial resistance [ 91 , 92 ].…”

Bacterial Community and Genomic Analysis of Carbapenem-Resistant Acinetobacter baumannii Isolates from the Environment of a Health Care Facility in the Western Region of Saudi Arabia

“…Previously, a relatively high abundance of HAIs from Gram-negative bacteria, such as E. coli , Klebsiella species, and P. aeruginosa , was reported in the multi-hospital health care system in Saudi Arabia [ 23 ]. These nosocomial pathogens have the ability to colonize medical devices and hospital environment, and they can cause high morbidity and mortality in surgery, oncology, hematology, burn, and ICU patients [ 1 , 27 , 31 ].…”

“…These nosocomial pathogens have the ability to colonize medical devices and hospital environment, and they can cause high morbidity and mortality in surgery, oncology, hematology, burn, and ICU patients [ 1 , 27 , 31 ]. Infections caused by these virulent bacteria are difficult to control and treat because of their increasing resistance to many antimicrobial agents [ 23 ]. In this study, a relatively low percentage of P. aeruginosa isolates were identified.…”

“…Many factors can interfere with the control of nosocomial infections, notably the specific types of bacteria and their resistance to antimicrobial agents. Physicians face difficulty finding effective treatments to treat infections from MDR bacteria in chronic care facilities [ 7 , 23 , 36 ]. Important antibiotics such as penicillin, semi-synthetic penicillin, and first- and second-generation cephalosporin are losing efficacy [ 7 , 37 ].…”

“…The available literature highlights that HAIs represent a critical issue in the health care facilities of Saudi Arabia [ 9 , 23 , 24 ]. A study from Abha General Hospital showed that 14% of the patients admitted to neonatal intensive care units acquired a nosocomial infection [ 25 ].…”