{
  "abstract": "Background: Enterobacter species are increasingly associated with antimicrobial non-susceptibility, but long-term surveillance of temporal trends across antibiotic classes is limited in southern Saudi Arabia. Methods: We retrospectively studied non-duplicate Enterobacter isolates from adults at a tertiary-care hospital in southern Saudi Arabia (August 2012–August 2024), interpreted by contemporaneous CLSI criteria. Temporal trends were modelled by logistic regression as the annual percent change (APC) in the odds of non-susceptibility, adjusted for care setting, specimen source, age, and sex. Carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat resistance (DTR; Kadri criteria) were analysed over time; sensitivity analyses excluded partial years and used breakpoint-comparable periods. Results: Of 1,319 Enterobacter isolates, 91.8% belonged to the Enterobacter cloacae complex. Adjusted trends declined for amikacin (APC −6.1%), gentamicin (−9.4%) and cefepime (−9.1%) and rose for carbapenems (+13.1% to +15.8%), levofloxacin (+6.3%) and piperacillin–tazobactam (+7.0%), with ciprofloxacin stable. The levofloxacin and piperacillin–tazobactam increases did not persist in breakpoint-comparable analyses and are not unequivocal biological increases. Inpatient isolates were more non-susceptible than outpatient isolates by approximately 16–39 percentage points (gentamicin 31.7% vs 14.8%; piperacillin–tazobactam 38.7% vs 23.1%; cefotaxime 63.9% vs 41.5%; cefepime 45.7% vs 28.8%; ceftazidime 61.4% vs 35.3%; ceftriaxone 57.4% vs 18.8%; all p ≤ 0.003). CRE rose early and remained common (APC + 22.8%; 28.7% overall), whereas DTR rose later and stayed infrequent (7.5% of eligible isolates; APC + 16.4%; highest annual value 20.2% in 2023); this difference in timing and overall frequency, not the partially sampled year 2024, indicates dissociation between carbapenem non-susceptibility and loss of all first-line agents. Conclusion: Non-susceptibility among Enterobacter species was heterogeneous and antibiotic-specific. The dissociation between CRE and DTR in timing and overall frequency supports using clinically meaningful phenotypes alongside antibiotic-specific trend analysis for stewardship and reporting; the levofloxacin and piperacillin–tazobactam increases warrant caution, as they did not persist in breakpoint-comparable analyses.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Saudi Arabia",
    "Khamis Mushait General Hospital, Khamis Mushait, Saudi Arabia",
    "Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia",
    "Consultant Nephrology and Assistant Professor at King Khalid University, Abha, Saudi Arabia",
    "Department of Internal Medicine, Aseer Central Hospital, Abha, Saudi Arabia",
    "Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia",
    "Department of Haematology and Immunohaematology, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan",
    "Department of Family Medicine, Aseer Central Hospital, Abha, Saudi Arabia",
    "Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia",
    "Department of Microbiology, Aseer Central Hospital, Abha, Saudi Arabia"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yahya Shabi"
    },
    {
      "affs": [
        1
      ],
      "name": "Fatimah Mohmmed Ali Asiri"
    },
    {
      "affs": [
        2
      ],
      "name": "Khalifa Binkhamis"
    },
    {
      "affs": [
        3
      ],
      "name": "Ali M. Somily"
    },
    {
      "affs": [
        4
      ],
      "name": "Mona M. Alshahrani"
    },
    {
      "affs": [
        5
      ],
      "name": "Tarik Alazraqi"
    },
    {
      "affs": [
        6
      ],
      "name": "Safia Abdullah Mohammed"
    },
    {
      "affs": [
        7
      ],
      "name": "Sara Habbash"
    },
    {
      "affs": [
        8
      ],
      "name": "Ali Al Bshabshe"
    },
    {
      "affs": [
        9
      ],
      "name": "Soliuman Mohamed"
    },
    {
      "name": "Abdullah Algarni"
    },
    {
      "name": "Ahmadiyah Siddiq"
    },
    {
      "name": "Abdulah O. S. Bawazeer"
    },
    {
      "name": "Abdulah J. Alqahtani"
    },
    {
      "name": "Abdullah A. Al-Shahrani"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3d0327944k6dd.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0358963",
  "fulltext_url": null,
  "id": "3d0327944k6dd",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0358963",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "1313|Antibiotic Resistance in Bacteria"
    ],
    [
      "plos",
      "/Biology and life sciences/Cell biology/Cellular types/Animal cells/Immune cells/Antigen-presenting cells"
    ],
    [
      "plos",
      "/Biology and life sciences/Immunology/Immune cells/Antigen-presenting cells"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Bacterial pathogens/Enterobacter"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Microbial control/Antimicrobials"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Microbial control/Antimicrobials/Antibiotics"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Microbial control/Antimicrobials/Antibiotics/Tetracyclines"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Bacteria/Enterobacter"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Patients/Inpatients"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Patients/Outpatients"
    ],
    [
      "plos",
      "/Medicine and health sciences/Immunology/Immune cells/Antigen-presenting cells"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Infectious diseases/Bacterial diseases/Enterobacter infections"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Bacterial pathogens/Enterobacter"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Drugs/Antimicrobials"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Drugs/Antimicrobials/Antibiotics"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Drugs/Antimicrobials/Antibiotics/Tetracyclines"
    ]
  ],
  "openalex": "W7222763120",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0358963&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-16",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/3d0327944k6dd.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:23Z",
      "native_id": "10.1371/journal.pone.0358963",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0358963"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "plos:immunology",
      "subfield": "immunology"
    },
    {
      "field": "biology",
      "origin": "plos:microbiology",
      "subfield": "microbiology"
    },
    {
      "field": "medicine",
      "origin": "plos:pharmacology",
      "subfield": "pharmacology-toxicology"
    }
  ],
  "title": "Laboratory-based surveillance of antimicrobial non-susceptibility in Enterobacter species over 12 years at a tertiary-care hospital in Saudi Arabia",
  "title_text": "Laboratory-based surveillance of antimicrobial non-susceptibility in Enterobacter species over 12 years at a tertiary-care hospital in Saudi Arabia",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:23Z",
  "url": "https://research.draconitic.com/paper/3d0327944k6dd",
  "venue": "PLOS One",
  "versions": []
}