{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:50:29Z","timestamp":1792788629406,"version":"4.5.0"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Research and Graduate Studies, King Khalid University","award":["RGP1\/289\/46"],"award-info":[{"award-number":["RGP1\/289\/46"]}],"id":[{"id":"https:\/\/ror.org\/052kwzs30","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      is a leading cause of infection, and methicillin-resistant\n                      <jats:italic>S. aureus<\/jats:italic>\n                      (MRSA) is a high-priority resistance threat. MRSA and methicillin-susceptible\n                      <jats:italic>S. aureus<\/jats:italic>\n                      (MSSA) differ in non-\u03b2-lactam resistance, yet longitudinal data from Aseer, Saudi Arabia are limited. We characterized methicillin-resistance and non-susceptibility trends to inform local stewardship.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective laboratory-based surveillance study of 4,194\n                      <jats:italic>S. aureus<\/jats:italic>\n                      isolates from 3,122 patients (aged \u226512 years) at a tertiary-care center in Aseer, Saudi Arabia (January 2013\u2013June 2024). Isolates were classified as MRSA or MSSA by oxacillin\/cefoxitin testing to CLSI standards. We estimated annual non-susceptibility proportions and their temporal trends, compared non-susceptibility between MRSA and MSSA, and identified independent predictors of MRSA in a multivariable model accounting for repeated isolates from the same patient.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>MRSA accounted for 2,231 isolates (53.2%; 95% CI 51.7\u201354.7) and MSSA for 1,963 (46.8%); most isolates were from inpatients, including 1,975\/2,231 MRSA isolates (88.5%) and 1,648\/1,963 MSSA isolates (84.0%). The MRSA share rose from 47.4% (2013) to 60.4% (2024), each later year being independently associated with MRSA (adjusted OR 1.09\/year, 95% CI 1.06\u20131.12). MRSA was significantly more non-susceptible than MSSA to penicillin, ciprofloxacin, levofloxacin, erythromycin, clindamycin, gentamicin, trimethoprim\u2013sulfamethoxazole, tetracycline, fusidic acid and rifampin (all FDR-adjusted p\u2009&lt;\u20090.05), with the widest gap for fusidic acid (62.7% vs 25.0%); fusidic-acid and fluoroquinolone non-susceptibility also increased over time. No vancomycin or daptomycin non-susceptibility was detected; teicoplanin non-susceptibility was low but significantly higher in MRSA (2.8% vs 1.5%), and low-level linezolid non-susceptibility (1.5% vs 1.3%) was not confirmatory-tested.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In this single-center Aseer surveillance, MRSA became the majority of\n                      <jats:italic>S. aureus<\/jats:italic>\n                      during 2013\u20132024 and showed broad multidrug non-susceptibility, while vancomycin and daptomycin retained full in vitro activity. These local findings support sustained laboratory-based surveillance, Aseer-tailored empirical and stewardship guidance, and confirmatory testing of the emerging low-level linezolid non-susceptibility signal.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0357789","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:25:41Z","timestamp":1789493141000},"page":"e0357789","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Methicillin resistance and antimicrobial non-susceptibility trends among Staphylococcus aureus clinical isolates in Aseer, Saudi Arabia (2013\u20132024): A retrospective laboratory-based surveillance study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1113-6387","authenticated-orcid":true,"given":"Abdulah J.","family":"Alqahtani","sequence":"first","affiliation":[{"name":"College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Microbiology and Clinical Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahya","family":"Shabi","sequence":"additional","affiliation":[{"name":"College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Microbiology and Clinical Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2367-3361","authenticated-orcid":true,"given":"Ghaday","family":"Hadi","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons","place":["Dublin, Ireland"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1477-4379","authenticated-orcid":true,"given":"Abdullah","family":"Algarni","sequence":"additional","affiliation":[{"name":"Aseer Central Hospital","place":["Abha, Saudi Arabia"],"department":["Department of Family Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anandhalakshmi","family":"Subramanian","sequence":"additional","affiliation":[{"name":"College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Microbiology and Clinical Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ihab M.","family":"Abdelrahim","sequence":"additional","affiliation":[{"name":"College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Microbiology and Clinical Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0974-7226","authenticated-orcid":true,"given":"Ali","family":"Al bshabshe","sequence":"additional","affiliation":[{"name":"College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarik","family":"Alazraqi","sequence":"additional","affiliation":[{"name":"Aseer Central Hospital","place":["Abha, Saudi Arabia"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safia Abdullah","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Aseer Central Hospital","place":["Abha, Saudi Arabia"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Habbash","sequence":"additional","affiliation":[{"name":"Aseer Central Hospital","place":["Abha, Saudi Arabia"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona M.","family":"Alfaki","sequence":"additional","affiliation":[{"name":"College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Microbiology and Clinical Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulah O. 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