Three Years of Evaluation to Determine Reduction of Antibiotic Resistance in Gram-Negative Bacteria by the Saudi National Action Plan

BACKGROUND: Bacterial antibiotic resistance (AR) is a primary public health concern. In 2017, the Saudi National Action Plan (SNAP) implemented several strategies to overcome AR. Here, to better understand the effectiveness of that plan, we evaluated the rates of AR, extended-spectrum beta-lactamase (ESBL) positivity, and multi-drug resistance (MDR) among gram-negative bacteria in a private Saudi hospital. METHODS: This retrospective study included all patients with a confirmed diagnosis of gram-negative bacterial infection from January 2017 to December 2019. Identification of bacterial strains was performed using VITEK 2 ID-GNB cards, while AR, ESBL, and MDR were determined using AST-No. 12 cards, both used as recommended by the manufacturer. Cards were loaded into a VITEK 2 system for examination. RESULTS: A total of 4760 isolated gram-negative bacteria were collected. The most isolated organism was Escherichia coli, with 2585/4760 (54.30%) strains, and the least was Providencia stuartii, with 55/4760 (1.16%) strains. A total of 1328/4760 (27.90%) clinical isolates were ESBL-positive, and 851/4760 (17.88%) possessed MDR. Escherichia coli was also the most frequently isolated as having ESBL activity and MDR, with 772/1328 (58.13%) and 292/851 (34.31%) isolates, respectively. Between 2017 and 2019, the rates of ESBL and MDR were significantly reduced (p < 0.05) for most bacteria, except for Salmonella species, which showed increased resistance to antibiotics. CONCLUSION: Our findings revealed that the rates of AR, ESBL, and MDR reduced over time, which suggests the SNAP is effective at overcoming AR risk.