Frequency and Antibiotic Susceptibility of Gram-Negative Bacteria in Saudi Arabian Hospitals: A Comprehensive Review

The emergence of antimicrobial resistance in Gram-negative bacteria poses an increasing threat to public health worldwide, including in Saudi Arabia. The healthcare system in the Kingdom is under increasing pressure due to the prevalence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacterial strains, particularly species such as Escherichia coli, Klebsiellapneumoniae, Pseudomonas aeruginosa, and Acinetobacterbaumannii. These bacteria are major causes of hospital-acquired infections, especially in intensive care units, where the most vulnerable patients are at highest risk. This study aims to review current data on the prevalence of antimicrobial resistance in Gram-negative bacteria in Saudi hospitals, resistance patterns, resistance mechanisms, and key contributing factors. It also addresses strategies for improving clinical management and preventive interventions. A comprehensive review of peer-reviewed scientific publications from 2010 to 2025 was conducted, using data from PubMed, Google Scholar, and official Saudi health databases. Data were categorized by bacterial species, geographic region, type of infection, and resistance patterns. The results showed very high resistance rates to commonly used antibiotics, such as carbapenems, aminoglycosides, fluoroquinolones, and third-generation cephalosporins. The problem of resistance in Acinetobacterbaumannii and Pseudomonas aeruginosa is particularly severe. The prevalence of Escherichia coli and Klebsiellapneumoniae producing extended-spectrum beta-lactamase (ESBL) further reduces treatment options. Common resistance genes include blaKPC, blaNDM, and blaOXA-48. Contributing factors include the misuse of antibiotics and weak antibiotic stewardship programs. Unique regional factors, such as the influx of international pilgrims during the Hajj season, further complicate the issue. Levels of resistance vary across regions, with the central and western regions experiencing the highest rates. Addressing antimicrobial resistance in Saudi Arabia requires an integrated, multi-dimensional approach, encompassing enhanced national surveillance, strengthened antibiotic stewardship programs, the use of rapid diagnostic tools, and improved infection control measures. Particular attention should also be given to research into alternative treatments, such as bacteriophage therapy or novel antibiotic formulations. Addressing this public health crisis necessitates ongoing collaboration at both national and international levels to ensure better clinical outcomes and protect public health.