{"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":1792788629157,"version":"4.5.0"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"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>Enterobacter<\/jats:italic>\n                      species are increasingly associated with antimicrobial non-susceptibility, but long-term surveillance of temporal trends across antibiotic classes is limited in southern Saudi Arabia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively studied non-duplicate\n                      <jats:italic>Enterobacter<\/jats:italic>\n                      isolates from adults at a tertiary-care hospital in southern Saudi Arabia (August 2012\u2013August 2024), interpreted by contemporaneous CLSI criteria. Temporal trends were modelled by logistic regression as the annual percent change (APC) in the odds of non-susceptibility, adjusted for care setting, specimen source, age, and sex. Carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat resistance (DTR; Kadri criteria) were analysed over time; sensitivity analyses excluded partial years and used breakpoint-comparable periods.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1,319\n                      <jats:italic>Enterobacter<\/jats:italic>\n                      isolates, 91.8% belonged to the\n                      <jats:italic>Enterobacter cloacae<\/jats:italic>\n                      complex. Adjusted trends declined for amikacin (APC \u22126.1%), gentamicin (\u22129.4%) and cefepime (\u22129.1%) and rose for carbapenems (+13.1% to +15.8%), levofloxacin (+6.3%) and piperacillin\u2013tazobactam (+7.0%), with ciprofloxacin stable. The levofloxacin and piperacillin\u2013tazobactam increases did not persist in breakpoint-comparable analyses and are not unequivocal biological increases. Inpatient isolates were more non-susceptible than outpatient isolates by approximately 16\u201339 percentage points (gentamicin 31.7% vs 14.8%; piperacillin\u2013tazobactam 38.7% vs 23.1%; cefotaxime 63.9% vs 41.5%; cefepime 45.7% vs 28.8%; ceftazidime 61.4% vs 35.3%; ceftriaxone 57.4% vs 18.8%; all p\u2009\u2264\u20090.003). CRE rose early and remained common (APC\u2009+\u200922.8%; 28.7% overall), whereas DTR rose later and stayed infrequent (7.5% of eligible isolates; APC\u2009+\u200916.4%; highest annual value 20.2% in 2023); this difference in timing and overall frequency, not the partially sampled year 2024, indicates dissociation between carbapenem non-susceptibility and loss of all first-line agents.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Non-susceptibility among\n                      <jats:italic>Enterobacter<\/jats:italic>\n                      species was heterogeneous and antibiotic-specific. The dissociation between CRE and DTR in timing and overall frequency supports using clinically meaningful phenotypes alongside antibiotic-specific trend analysis for stewardship and reporting; the levofloxacin and piperacillin\u2013tazobactam increases warrant caution, as they did not persist in breakpoint-comparable analyses.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358963","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:31:42Z","timestamp":1792171902000},"page":"e0358963","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Laboratory-based surveillance of antimicrobial non-susceptibility in Enterobacter species over 12 years at a tertiary-care hospital in Saudi Arabia"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2489-4531","authenticated-orcid":true,"given":"Yahya","family":"Shabi","sequence":"first","affiliation":[{"name":"King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Microbiology and Clinical Parasitology, College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatimah Mohmmed Ali","family":"Asiri","sequence":"additional","affiliation":[{"name":"Khamis Mushait General Hospital","place":["Khamis Mushait, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5425-9531","authenticated-orcid":true,"given":"Khalifa","family":"Binkhamis","sequence":"additional","affiliation":[{"name":"King Saud University","place":["Riyadh, Saudi Arabia"],"department":["Department of Pathology, College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali M.","family":"Somily","sequence":"additional","affiliation":[{"name":"King Saud University","place":["Riyadh, Saudi Arabia"],"department":["Department of Pathology, College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona M.","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"Consultant Nephrology and Assistant Professor at King Khalid University","place":["Abha, Saudi Arabia"]}],"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"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3477-4895","authenticated-orcid":true,"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":"Ali","family":"Al Bshabshe","sequence":"additional","affiliation":[{"name":"King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Medicine, College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soliuman","family":"Mohamed","sequence":"additional","affiliation":[{"name":"University of Khartoum","place":["Khartoum, Sudan"],"department":["Department of Haematology and Immunohaematology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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":"Ahmadiyah","family":"Siddiq","sequence":"additional","affiliation":[{"name":"College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulah O. S.","family":"Bawazeer","sequence":"additional","affiliation":[{"name":"Aseer Central Hospital","place":["Abha, Saudi Arabia"],"department":["Department of Microbiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1113-6387","authenticated-orcid":true,"given":"Abdulah J.","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Microbiology and Clinical Parasitology, College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah A.","family":"Al-Shahrani","sequence":"additional","affiliation":[{"name":"King Khalid University","place":["Abha, Saudi Arabia"],"department":["Department of Medicine, College of 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