Antimicrobial Resistance Trends in Carbapenem-Resistant Enterobacterales in a Saudi Healthcare Setting

Longitudinal data on carbapenem-resistant Enterobacterales (CRE) from Saudi secondary healthcare settings remain limited. This study evaluated eight-year antimicrobial resistance trends among CRE isolates to provide locally relevant evidence for antimicrobial stewardship and empiric therapy. This retrospective surveillance study analyzed Enterobacterales isolates recovered from clinical specimens between 2017 and 2024 from a Saudi healthcare setting. Isolates were deduplicated by including only the first isolate per patient per year. CRE were defined as Enterobacterales demonstrating non-susceptibility to imipenem or meropenem. Demographic data, specimen sources, species distribution, and antimicrobial resistance profiles were summarized descriptively. Temporal trends in CRE prevalence and antimicrobial non-susceptibility were evaluated using logistic regression. Factors associated with CRE were assessed using multivariable logistic regression analyses. A total of 2378 Enterobacterales isolates were identified, of which 684 (28.8%) were CRE. CRE prevalence increased significantly over the study period, rising from 9.5% in 2017 to a peak of 40.1% in 2021 before declining to 27.1% in 2024. Multivariable logistic regression demonstrated that collection year (adjusted OR 1.12, 95% CI 1.08-1.17; p < 0.0001), male sex, and specimen source were independently associated with CRE. Klebsiella pneumoniae was the predominant species. High non-susceptibility rates were observed for cephalosporins and fluoroquinolones, while aminoglycosides and tigecycline demonstrated comparatively lower resistance. Significant temporal trends in non-susceptibility were observed for cefepime, ceftazidime, ciprofloxacin, and tigecycline. CRE represented a substantial proportion of Enterobacterales isolates and demonstrated extensive antimicrobial resistance. These findings highlight the importance of continuous local surveillance to inform empirical antimicrobial therapy, support antimicrobial stewardship, and monitor evolving resistance patterns.