The association between parenteral antimicrobials and bacterial resistance at King Khaled Hospital in Al-Kharj: A retrospective cohort study
Abstract
Antimicrobial resistance (AMR) is rising alarmingly in Saudi Arabia, as evidenced by surveillance data. This retrospective cohort study evaluated the association between parenteral antimicrobial use and bacterial resistance at King Khaled Hospital, Al-Kharj, using electronic health records. Linear regression analyzed antibiotic exposure-resistance relationships over 36 months (January 2022-December 2024). Eligible participants were hospitalized ≥ 48 h and received ≥ 1 parenteral antimicrobial. The required sample size was 384 (calculated via Cochran's formula). Inclusion mandated laboratory-confirmed bacterial infections (positive cultures with susceptibility testing). Investigated pathogens included Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus aureus. Among 4,007 participants, 59.02% were female, and 73.07% were Saudis. Findings revealed severe AMR, particularly in Escherichia coli and Klebsiella pneumoniae, with high resistance to multiple antibiotic classes. Acinetobacter baumannii exhibited near-pan-drug resistance (> 90% resistance to most antibiotics). Imipenem use strongly correlated with Escherichia coli resistance (R2 = 1.000, p-value = 0.009), indicating significant carbapenem-driven selection pressure. Meropenem exposure also closely linked to Klebsiella pneumoniae resistance (R2 = 0.994, p-value = 0.050). Widespread resistance to β-lactams, fluoroquinolones, and aminoglycosides-combined with…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 4,007 participants or records.
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