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Background Studying time-related changes in susceptible pathogens causing healthcare-associated infections (HAIs) is vital in improving local antimicrobial and infection control practices. Objectives Describe susceptibility patterns to several antimicrobials in gram-positive and gram-negative pathogens isolated from patients causing HAIs at three private tertiary care hospitals in Saudi Arabia over a 5-year period. Methods Data on trends of antimicrobial susceptibility among bacteria causing HAIs events in children and adults at three tertiary private hospitals located in Riyadh and Qassim, Saudi Arabia, were collected retrospectively between 2015 and 2019 using the surveillance data datasets. Results Over a 5-year period, 38,624 pathogens caused 17,539 HAI events in 17,566 patients. About 9450 (53.8%) of patients who suffered HAIs were females and the average age was 41.7 ± 14.3 years (78.1% were adults and 21.9% were children). Gram-negative pathogens were 2.3-times more likely to cause HAIs compared to gram-positive bacteria (71.9% vs. 28.1%). The ranking of causative pathogens in decreasing order was: Escherichia coli (38%), Klebsiella species (15.1%), and Staphylococcus aureus (12.6%). Gram-positive isolates were mostly susceptible to linezolid (91.8%) whereas they were resistant to ampicillin (52.6%), cefoxitin (54.2%), and doxycycline (55.9%). Gram-negative isolates were mostly sensitive to tigecycline (95%) whereas they were resistant to cefotaxime (49.5%) and cefixime (59.6%). During the 5 years, there were relatively stable susceptibility patterns to all tested antimicrobials, except for cefotaxime which shown a susceptibility reduction by 41.4%, among Escherichia coli and Klebsiella species. An increase in the susceptibility of Acinetobacter and Enterobacter and Citrobacter species to all studied antimicrobials was observed except for colistin that had a slight sensitivity reduction in 2019 by 4.3% against Acinetobacter species. However, we noted reduced sensitivity of MRSA, CoNS and Enterococcus species to gentamicin; and increased resistance of MRSA to linezolid and vancomycin. Conclusion The observed increase in susceptibility of gram-positive and gram-negative bacteria to studied antimicrobials is important; however, reduced sensitivity of MRSA, CoNS and Enterococcus species to gentamicin; and increased resistance of MRSA to linezolid and vancomycin is a serious threat and calls for effective antimicrobial stewardship programs.

Purpose : To examine virulence (severity of disease and/or symptoms) and response to therapy (medications, supportive measures) between confirmed cases of MERS-CoV animal-to-human transmission compared with cases resulting from human-to-human transmission. Methods : The records for laboratory-confirmed MERS-CoV infections that were diagnosed at King Fahad Hofuf Hospital (Al-Ahsa, Saudi Arabia) from April 1, 2012 to November 30, 2016 were reviewed retrospectively. Results : There were 107 laboratory-confirmed MERS-CoV cases. Transmission of the virus from animal-to-human was less common (21.4 vs 78.6 %). The human-to-human transmission group had a higher mortality rate (53.57 vs 39.13 %). Patients in this group also had higher APACHEE II (11.2 vs 23, p = 0.043), SOFA scores (10.9 vs 12.55, p = 0.076), and higher rates of sepsis (17.39 vs 26.19 %, p = 0.582) and septic shock (13.04 vs 20.23 %, p = 0.555). The infections were more severe in the humanto- human transmission group; patients had increased rates of intensive care unit (ICU) admission (43.47 vs 51.19 %), decreased time from symptom onset until ICU admission, and greater need for mechanical ventilation (8 days vs 4 days, p = 0.041, and 6 days vs 4 days, respectively), longer time to respond to antiviral treatment and resolve the infection (5 days vs 11 days and 7 days vs 13 days, respectively) and a shorter time from the beginning of symptoms until death (11 days vs 5 days, p = 0.048). Conclusion : MERS-CoV transmitted from human-to-human was more virulent, resulted in higher casemortality rates and required more ICU treatment. Keywords : Animal-to-human, Human-to-human, MERS-CoV, Outcomes, Primary infection, Secondary infection, Virulence