ArticleFrontiers in cellular and infection microbiology2026
Difficult-to-treat resistance, not carbapenem non-susceptibility, is associated with 30-day mortality in respiratory gram-negative bacilli: a 12-year surveillance cohort.
Article in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Antimicrobial resistance in respiratory gram-negative bacilli (GNB) is rising in Saudi Arabia, yet the clinical impact of difficult-to-treat resistance (DTR) remains poorly defined. We characterized temporal trends in organism distribution, non-susceptibility phenotypes, and their association with 30-day in-hospital mortality. Methods: Retrospective cohort of hospitalized patients aged ≥12 years with culture-positive respiratory GNB at a referral hospital in southern Saudi Arabia (January 2013-August 2024). Non-susceptibility phenotypes were fluoroquinolone (FQ-NS), extended-spectrum cephalosporin (ESC-NS), carbapenem non-susceptibility, and DTR. Trends were assessed with segmented binomial regression, mortality with modified Poisson regression. Results: Among 6,999 isolate-episodes from 3,808 patients, Enterobacterales (57.2%) increased while non-fermenting GNB declined (AAPC, -2.5%). Carbapenem non-susceptibility rose among Enterobacterales (AAPC, + 5.4%), driven by Conclusions: Respiratory GNB epidemiology is shifting toward Enterobacterales with rising resistance. DTR, not carbapenem non-susceptibility alone, was consistently associated with 30-day mortality and provides a meaningful framework for risk stratification and resistance-centered surveillance.
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