{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T07:04:43Z","timestamp":1784790283505,"version":"3.55.0"},"reference-count":15,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007446","name":"Deanship of Graduate Studies and Scientific Research at King Khalid University","doi-asserted-by":"publisher","award":["RGP1\/16\/47"],"award-info":[{"award-number":["RGP1\/16\/47"]}],"id":[{"id":"10.13039\/501100007446","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>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\u20131.17; p &lt; 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.<\/jats:p>","DOI":"10.3390\/microorganisms14081604","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T06:11:42Z","timestamp":1784787102000},"page":"1604","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antimicrobial Resistance Trends in Carbapenem-Resistant Enterobacterales in a Saudi Healthcare Setting"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4484-6994","authenticated-orcid":false,"given":"Wael A.","family":"Alghamdi","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62223, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6651-2306","authenticated-orcid":false,"given":"Khalid M.","family":"Orayj","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62223, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah M.","family":"Alshehri","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62223, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed A.","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Khamis Mushait General Hospital, Khamis Mushait 62433, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed R. N.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62223, Saudi Arabia"},{"name":"Faculty of Pharmacy, Minia University, Minia 61519, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1080\/21505594.2016.1222343","article-title":"The Global Epidemiology of Carbapenemase-Producing Enterobacteriaceae","volume":"8","author":"Doi","year":"2017","journal-title":"Virulence"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1093\/cid\/cis588","article-title":"Predictors of Mortality in Bloodstream Infections Caused by Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae: Importance of Combination Therapy","volume":"55","author":"Tumbarello","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1128\/CMR.05035-11","article-title":"Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: An Evolving Crisis of Global Dimensions","volume":"25","author":"Tzouvelekis","year":"2012","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S1473-3099(17)30753-3","article-title":"Discovery, Research, and Development of New Antibiotics: The WHO Priority List of Antibiotic-Resistant Bacteria and Tuberculosis","volume":"18","author":"Tacconelli","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"127249","DOI":"10.1016\/j.micres.2022.127249","article-title":"Global Spread of Carbapenem-Resistant Enterobacteriaceae: Epidemiological Features, Resistance Mechanisms, Detection and Therapy","volume":"266","author":"Ma","year":"2023","journal-title":"Microbiol. Res."},{"key":"ref_6","first-page":"102186","article-title":"Prevalence of Carbapenem-Resistant Enterobacterales (CRE) in Saudi Arabia: A Systematic Review and Meta-Analysis","volume":"32","author":"Alshehri","year":"2024","journal-title":"Saudi Pharm. J. SPJ Off. Publ. Saudi Pharm. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1128\/CMR.00096-12","article-title":"\u03b2-Lactamase Production in Key Gram-Negative Pathogen Isolates from the Arabian Peninsula","volume":"26","author":"Zowawi","year":"2013","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1093\/trstmh\/trab055","article-title":"Genotypes and Prevalence of Carbapenemase-Producing Enterobacteriaceae and Pseudomonas Aeruginosa in a Hospital in Saudi Arabia","volume":"116","author":"Rabaan","year":"2022","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_9","first-page":"e35050","article-title":"Prevalence of Carbapenem-Resistant Enterobacteriaceae in Western Saudi Arabia and Increasing Trends in the Antimicrobial Resistance of Enterobacteriaceae","volume":"15","author":"Taha","year":"2023","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Thomsen, J., Abdulrazzaq, N.M., UAE AMR Surveillance Consortium, Everett, D.B., Menezes, G.A., Senok, A., and Ayoub Moubareck, C. (2023). Carbapenem Resistant Enterobacterales in the United Arab Emirates: A Retrospective Analysis from 2010 to 2021. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1244482"},{"key":"ref_11","unstructured":"Clinical and Laboratory Standards Institute (2025). Performance Standards for Antimicrobial Susceptibility Testing, Clinical and Laboratory Standards Institute. [35th ed.]. CLSI Supplement M100."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.cmi.2022.12.006","article-title":"Antibiotic Resistance Associated with the COVID-19 Pandemic: A Systematic Review and Meta-Analysis","volume":"29","author":"Langford","year":"2023","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e208","DOI":"10.1017\/ash.2023.477","article-title":"Impact of COVID-19 Pandemic on Carbapenem-Resistant Enterobacterales Incidence in the South-East Asia Region: An Observational Study","volume":"3","author":"Linn","year":"2023","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Fasciana, T., Antonelli, A., Bianco, G., Lombardo, D., Codda, G., Roscetto, E., Perez, M., Lipari, D., Arrigo, I., and Galia, E. (2023). Multicenter Study on the Prevalence of Colonization Due to Carbapenem-Resistant Enterobacterales Strains before and during the First Year of COVID-19, Italy 2018\u20132020. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1270924"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Caliskan-Aydogan, O., and Alocilja, E.C. (2023). A Review of Carbapenem Resistance in Enterobacterales and Its Detection Techniques. Microorganisms, 11.","DOI":"10.3390\/microorganisms11061491"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/8\/1604\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T06:20:28Z","timestamp":1784787628000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/8\/1604"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":15,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["microorganisms14081604"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14081604","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}