A review of the burden, resistance patterns and outcomes of hospitalacquired infections in Saudi Arabia.

Abstract

Background: Hospital-acquired infections remain a major problem in Saudi Arabia, contributing to increases in morbidity, mortality and health care costs.

Aim: To review evidence on the epidemiology, risk factors and outcomes of hospital-acquired infections in Saudi Arabia hospitals.

Methods: Following PRISMA 2020 guidelines and narrative synthesis approach, we searched PubMed/Medline and Web of Science, as well as the databases of Google Scholar, Multidisciplinary Digital Publishing Institute, and Springer Nature, for articles published between 2015 and 2025 on hospital and health care-associated infections in Saudi Arabia. We appraised the quality of the studies using the Newcastle-Ottawa scale, Joanna Briggs Institute and risk of bias in nonrandomized studies of interventions tools.

Results: Surgical site infections were ≤1%, but higher among caesarean section cohorts (≈4.7%). Gram-negative pathogens (Klebsiella, E. coli, Pseudomonas, Acinetobacter) were predominant, with ≈41% multidrug resistance and ≈25% extensive resistance. Risk factors for infection included intensive care unit stay, use of invasive devices, diabetes, and prolonged procedures. Bundle adherence was high (≈94-100%), but hand hygiene compliance lagged (≈76%). Reported outcomes included longer intensive care unit stay, increased antibiotic use and high mortality in severe central line-associated bloodstream infection cases.

Conclusion: Hospital-acquired infections in Saudi Arabia are predominantly associated with the use of invasive devices and driven by resistant gram-negative bacteria. Although national surveillance and bundle programmes have helped improve infection prevention in hospitals, there is a need for strict adherence to antimicrobial stewardship guidelines, enforcement of hand hygiene practices and uniform surgical site infection surveillance methods.