Epidemiology and Outcomes of Ventilator-Associated Pneumonia in Saudi Arabian Intensive Care Units: A Systematic Review and Meta-Analysis

Ventilator-associated pneumonia (VAP) remains a major healthcare-associated infection in intensive care units (ICUs) and is associated with prolonged hospitalization, increased antimicrobial use, and high mortality. In Saudi Arabia, evidence on VAP epidemiology, microbiology, and outcomes is fragmented across settings. This study aimed to systematically review and synthesise the available evidence on VAP in Saudi Arabian ICUs. This study followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420261332740). A systematic search of PubMed, MEDLINE, Embase, and Web of Science was conducted for studies published between 2015 and 2025. Studies from Saudi Arabia reporting VAP incidence in ICUs were included. A random-effects model was used to pool incidence per 1000 ventilator-days. Risk of bias was assessed using Joanna Briggs Institute tools. Analyses were performed using R. Seven studies involving a total of 15,844 patients, representing multicentre studies, national surveillance data, and single-centre cohorts across diverse ICU settings. The pooled incidence of VAP was 8.50 episodes per 1000 ventilator-days (95% CI: 3.23–13.78), with substantial heterogeneity (I2 = 97%). Subgroup analysis showed higher incidence during baseline phases (12.46 per 1000 ventilator-days) compared with intervention phases (8.06 per 1000 ventilator-days), while surveillance estimates were lower. Gram-negative pathogens predominated, particularly Acinetobacter baumannii, often exhibiting multidrug resistance. VAP was associated with prolonged ICU stay, delayed extubation, and high mortality. Implementation of infection prevention bundles was associated with reductions in VAP incidence. Ventilator-associated pneumonia remains a significant burden in Saudi Arabian ICUs, characterised by substantial variability in incidence and a predominance of multidrug-resistant pathogens. Strengthening infection prevention measures, enhancing antimicrobial stewardship, and improving national surveillance systems are essential to reduce VAP burden and improve patient outcomes.