Prevalence of Carbapenem-Resistant Enterobacteriaceae in Intensive Care Units in Saudi Arabia: A 10-Year Systematic Review.

Objective: To synthesize research on the prevalence and distribution patterns of carbapenem-resistant Enterobacteriaceae (CRE) in Intensive Care Units (ICUs) across Saudi Arabia. It also seeks to evaluate molecular resistance profiles, identify associated risk factors, assess antimicrobial susceptibility, and examine infection control strategies within these critical care settings.

Methods: A systematic analysis was conducted, including cross-sectional, retrospective, and genomic studies from various tertiary hospitals in Saudi Arabia. The review focused on epidemiological trends, molecular characterization of CRE strains, clinical correlates, and the outcomes of implemented intervention strategies.

Results: The findings indicate a high and steadily increasing prevalence of CRE, often exceeding 40% in ICUs. The predominant carbapenemase genes identified were blaOXA-48 and blaNDM, with evidence of clonal dissemination of high-risk strains. Key risk factors for CRE colonization and infection include ICU admission, use of invasive devices, prior antibiotic exposure, and comorbidities such as chronic kidney disease and diabetes. CRE isolates demonstrate extensive multidrug resistance, with colistin and tigecycline remaining effective options; however, emerging resistance to these agents has been reported. Although infection control measures like active surveillance and environmental cleaning are prioritized, their overall effectiveness remains under-evaluated and inconsistently documented.

Conclusion: The high and rising prevalence of CRE in Saudi Arabian ICUs underscores the urgent need for standardized molecular diagnostics, comprehensive surveillance systems, and targeted antimicrobial stewardship programs. Implementing these strategies is crucial to reducing CRE transmission, overcoming resistance challenges, and improving patient outcomes in critical care environments.