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Hadeel Alkofide,1 Abdullah M Alhammad,1,2 Alya Alruwaili,3 Ahmed Aldemerdash,1 Thamer A Almangour,1 Aseel Alsuwayegh,2 Daad Almoqbel,4 Aljohara Albati,5 Aljohara Alsaud,6 Mushira Enani7 1Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 2Department of Pharmacy Services, King Khalid University Hospital – King Saud University Medical City, Riyadh, Saudi Arabia; 3Department of Clinical Pharmacy, Pharmacy Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia; 4Credit Department, Saudi Industrial Development Fund, Riyadh, Saudi Arabia; 5Benefit Risk Assessment Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia; 6Biomedical Sciences, Alfaisal University, Riyadh, Saudi Arabia; 7Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi ArabiaCorrespondence: Hadeel Alkofide Department of Clinical PharmacyKing Saud University, College of Pharmacy, Riyadh 11149, Saudi ArabiaTel +966503225121Email halkofide@ksu.edu.saBackground: Drug-resistant gram-negative bacteria (GNB) are a global public health threat, especially in intensive care units (ICU). This study explored the prevalence of drug-resistant Enterobacteriaceae infections in an ICU in Saudi Arabia. The appropriateness of the antibiotic therapies used and their ability to improve the clinical outcomes were also assessed.Methods: A retrospective study was conducted from 2015 to 2018 in the different ICUs of a tertiary-care hospital in Saudi Arabia. Positive cultures for multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) Enterobacteriaceae, including Klebsiella pneumoniae, Escherichia coli, and Enterobacter sp., were included. The primary outcomes involved microbiological cure and 30 days in-hospital mortality rate, while the secondary outcome included the length of hospital stay (LOS). Regression models were used to assess the relationship between appropriateness of the antibiotic therapy and clinical outcomes.Results: Of the 227 Enterobacteriaceae cultures included in this study, 60% were either MDR (n= 130) or XDR (n= 8) infections; no PDR Enterobacteriaceae cultures were identified. Majority of the patients were female (54%), and the average age was 60.1 ± 17.7 years. MDR/XDR cultures primarily comprised E. coli (51.4%), followed by K. pneumoniae (33%) and Enterobacter sp. (16%). Most commonly used antibiotics were piperacillin/tazobactam (53%), carbapenems (47%), and cephalosporins (21.3%). Antibiotic therapy was considered appropriate in only 85 of 138 (61.59%) patients. Microbiological cure rate was achieved in 40% of the cases, and in-hospital death rate was 84%. The average LOS was 27 days. Appropriateness of the antibiotic therapy prescribed could not predict any of the study outcomes.Conclusion: The study revealed a high prevalence of drug-resistant Enterobacteriaceae infections, which were associated with a high mortality rate. Therefore, it is essential to assess the effectiveness of antimicrobial stewardship program and infection prevention and control practices, particularly in critically ill patients.Keywords: multidrug-resistant bacteria, extensively drug-resistant bacteria, Enterobacteriaceae