Survival Analysis of Patients with Antimicrobial-Resistant Infections in Saudi Arabia: Temporal Trends, Risk Factors and Intervention Outcomes (2015–2024)

Abstract Background: Antimicrobial resistance (AMR) is a major and rising problem for global health, leading to more illnesses, deaths and higher medical costs. Many factors contribute to AMR in Saudi Arabia, especially high antibiotic use, a lack of consistent antibiotic stewardship, and the yearly arrival of many international pilgrims, all of which lead to a greater risk of resistant pathogen transmission. The investigation employs survival analysis to measure mortality risks, observe changes in resistance over time, gauge the success of antimicrobial stewardship programmes (ASPs), and find out about regional variations in AMR. Methods: We analysed the cases of 18,742 patients with proven antimicrobial-resistant infections from 24 Saudi hospitals (included between 2015 and 2024). Testing antimicrobial susceptibility was done according to the Clinical and Laboratory Standards Institute guidelines, and a portion of the isolates was also investigated through molecular characterisation. The Kaplan–Meier and Cox proportional hazards models analysed 30- and 90-day mortality, considering time-dependent variables. Time-series analysis looked at how stewardship programmes affected outcomes, and any missing data were dealt with through multiple imputation. Results: Overall, 30-day mortality was 22.7% for carbapenem-resistant Enterobacteriaceae infections, 18.3% for methicillin-resistant Staphylococcus aureus , and 27.5% for multidrug-resistant Acinetobacter baumannii . Independent risk factors for mortality included advanced age (adjusted hazard ratio [aHR] =1.03 per year), intensive care unit admission (aHR = 2.78) and delayed appropriate therapy (aHR = 1.18 per day). Significant regional variations in resistance patterns were observed, with higher carbapenem resistance rates in central and western regions. Implementation of comprehensive ASPs was associated with a 32% reduction in mortality risk (aHR = 0.68) and significant decreases in resistance rates for key pathogens. An outline of the methodology, main conclusions, and justification for the study of the survival analysis of Saudi Arabian patients with antibiotic-resistant infections (2015–2024). Stewardship interventions were assessed, mortality risk factors were determined. Conclusions: This research offers the most detailed analysis of AMR results in Saudi Arabia so far. The results point out that more stewardship, standardised surveillance and better policy changes are essential now. Keeping track of both outcomes and resistance will provide guidance for combating AMR in Saudi Arabia and support the country’s Vision 2030 for healthcare improvements. Similar impacts on AMR management could also occur in other countries throughout the Gulf Cooperation Council region and beyond.