High post-surgical infection levels in Saudi Arabia

Antibiotic resistant bacteria are widespread in surgical-site infections in Saudi Arabian hospitals



According to the WHO, surgical-site infections (SSIs) are the most common healthcare-associated infections. In low- and middle-income countries, as many as 30% of patients who underwent surgeries had experienced surgical-site infections. Even in high-income countries, surgical-site infections account for more than one fifth of all healthcare-associated infections.

Surgical-site infections increase treatment costs, prolong hospitalization, and can lead to septic complications. To see how Saudi Arabia fares compared to other countries, Hanan Balkhy at the Infection Prevention and Control Department of King Abdulaziz Medical City in Riyadh and co-workers conducted a prevalence survey on surgical-site infections in four hospitals run by the Ministry of National Guard -Health Affairs (MNG-HA).

These four hospitals perform approximately 30,000 surgical procedures every year. The researchers’ survey targeted surgical procedures conducted between 2007 and 2016, with a focus on finding the causative pathogens of surgical-site infections and their antimicrobial resistance patterns.

Balkhy and her team recorded a total of 492 pathogens in 403 surgical-site infection cases. The most frequent pathogens found were Staphylococcus aureus (a Gram-positive bacterium frequently found on the skin), Pseudomonas aeruginosa (a Gram-negative bacterium found in soil, skin, as well as man-made environments), Klebsiella (a Gram-negative bacterium commonly found in the digestive tract), and Escherichia coli (a Gram-negative bacterium commonly found in the lower intestine).

Remarkably, all bacteria exhibited varying degrees of antimicrobial resistance. Some bacteria, such as Staphylococcus aureus, were found to be methicillin-resistant, while other bacteria such as Klebsiella and Escherichia coli displayed multi-drug resistance. Overall, Gram-negative bacteria with antimicrobial resistance were the most widespread pathogen, making up around 60% of all surgical site infections in the four hospitals.

Even more worrying is that, in comparison with US National Healthcare Safety Network hospitals, multi-drug resistant Klebsiella and Escherichia coli were significantly more common in Saudi Arabian hospitals.

The finding suggests that the current guidelines on the use of antibiotics before surgery might not be sufficient to tackle surgical-site infections. The researchers urge clinicians and health authorities in the Kingdom to secure resources and ensure support in implementing interventions, such as antimicrobial stewardship programmes and evidence-based preventive practices, to limit the number of surgical-site infection cases.


  1. El-Saed, A., Balkhy, H.H., Alshamrani, M.M., Aljohani, S., Alsaedi, A., et al. High contribution and impact of resistant gram negative pathogens causing surgical site infections at a multi-hospital healthcare system in Saudi Arabia, 2007–2016. BMC Infectious Diseases 20: 275 (2020). | article

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