Epidemiology, Molecular Characteristics, Treatment Patterns, and Outcomes of Carbapenem-Resistant Enterobacterales Infections in a Tertiary Hospital in Southern Saudi Arabia: A Retrospective Cohort Study.

Authors

Mushary Alqahtani, Ali Alshehri, Mohammed Alshehri, Bairam Jarallah, Naima Fasih, Sultan Alkahtani, Osama Asiri, Nejad Alnaem, Abdullah Gazwani, Abdulmajeed Alqahtani, Yahia Elsharif, Hatim Ayied, Maram Alshahrani, Ali Hawan

Published in

Journal of epidemiology and global health. Jul 13, 2026. Epub Jul 13, 2026.

Abstract

Carbapenem-resistant Enterobacterales (CRE) represent a growing public health challenge worldwide, particularly in healthcare settings where the options for treatment are limited, and the mortality rate is high. Data on the epidemiology, molecular characteristics, and clinical outcomes of CRE infections in southern Saudi Arabia are limited.
A retrospective cohort study was performed at a tertiary care hospital from 2021 to 2024, including adult patients with culture-confirmed CRE infections. Information on demographics, comorbidities, infection characteristics, antimicrobial therapy, molecular resistance mechanisms, and clinical outcomes was collected. Multivariable logistic regression analysis was performed to identify antibiotic-related predictors of poor outcomes, defined as a combination of 30-day mortality and treatment failure.
A total of 230 patients with infections caused by CRE were included in the study, with a mean age of 71.8 years; 96.1% of these patients had at least one comorbidity. The majority of the infections were hospital-acquired, with ventilator-associated pneumonia (31.7%) and bloodstream infections (27.8%) being the most prevalent. Klebsiella pneumoniae (K. pneumoniae) was responsible for 96.1% of the isolated cases. OXA-48 was identified as the predominant carbapenemase, occurring in 50.4% of cases, followed by combinations involving New Delhi metallo-beta-lactamase (NDM) and Klebsiella pneumoniae carbapenemase (KPC). The mortality rates at 30 days and 60 days were 54.3% and 65.2%, respectively. In the logistic regression analysis, ceftazidime-avibactam was associated with lower odds of poor outcome, while colistin and tigecycline were linked to higher odds; these results should be interpreted carefully due to the observational nature of the study.
CRE infections in this cohort were associated with high mortality and were predominantly caused by OXA-48-producing K. pneumoniae. These results emphasize the significant impact of CRE in southern Saudi Arabia and highlight the need for continuous monitoring, effective antimicrobial management, and the enhancement of treatment approaches from a public health standpoint.

PMID:
42439974
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.

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