Trends in antimicrobial resistance associated with gastrointestinal tract infections in the UAE: A comprehensive retrospective surveillance 13-year (2010-2022) study.

BACKGROUND

This study analyzes longitudinal trends in AMR among key bacterial pathogens causing GI infections across the United Arab Emirates (UAE), to inform future treatment policies and public health interventions.

METHODS

We conducted a 13-year, nationwide, longitudinal surveillance study (2010-2022) using data from 341 public and private healthcare facilities and 45 diagnostic laboratories across the UAE. Pathogen identification and antimicrobial susceptibility testing followed WHO GLASS standards, supplemented by WHONET-integrated electronic medical records. Statistical analyses assessed trends in pathogen incidence, resistance patterns, geographic distribution, and associations with clinical outcomes.

FINDINGS: Out of 15,593 laboratory-confirmed GI cases, the highest burden was observed in children aged 1-4 years (30.6%). Twelve major bacterial pathogens were identified, with non-typhoidal Salmonella (NTS) (68.2%), Shigella spp., and Escherichia coli as the most common. ICU admission risk was highest in patients infected with Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas spp., Proteus spp., and E. coli. Among Enterobacterales, resistance to carbapenems remained low (2.6%; 95% CI: 2.3-2.9), while resistance to third-generation cephalosporins was higher (8.5%; 95% CI: 8.0-9.0).

CONCLUSION

The burden of GI tract infections in the UAE is characterized by distinct pathogen distribution and variable antimicrobial resistance patterns across key bacterial species. While resistance to carbapenems remains low, higher resistance to third-generation cephalosporins among Enterobacterales is notable.