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Healthcare-associated outbreaks in Saudi Arabia are predominantly driven by multidrug-resistant organisms such as Candida auris and Klebsiella pneumoniae, resulting in a high overall mortality rate of 32.5% that is significantly predicted by advanced age, device use, and specific resistance patterns. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 10, 2026Open Access

Investigating the Epidemiology and Mortality of Healthcare-Associated Outbreaks in Saudi Arabia 2024: Retrospective Multicentric Study

Key Points

The study aims to investigate the epidemiology, microbial causes, resistance profiles, and mortality predictors of healthcare-associated outbreaks in Saudi Arabia.
Retrospective analysis of 1,934 notified outbreaks involving 3,700 patients in 2024.
Data collection included demographics, microbial profiles, resistance patterns, and outcomes.
Statistical analysis utilized SPSS with chi-squared tests, Kaplan–Meier survival analysis, and Cox proportional hazards models.
Most common pathogen was Candida auris with a fatality rate of 33.9%; overall mortality rate was 32.5%.
Increased mortality risk linked to geriatric patients (43.9%), bedridden individuals (50.0%), and device-related outbreaks.
Cox regression revealed age, outbreak class, and departmental transfer as mortality predictors, while absence of devices offered protective factors.

Abstract

Introduction: Healthcare-associated outbreaks are an increasing threat in healthcare systems, particularly in high-acuity settings. This study examined the epidemiology, microbial causes, resistance profiles, and mortality predictors among patients affected by outbreaks reported to the Saudi Ministry of Health (MOH) over one year. Methods: A retrospective analysis was conducted on 1,934 notified outbreaks during 2024, involving 3,700 patients. Cases were categorized by outcome (survived vs. deceased). Reported data included demographics, comorbidities, microbial profiles, resistance patterns, management, and outcomes. Data analysis was performed using SPSS version 25.0. Chi-squared tests, Kaplan–Meier survival analysis, and Cox proportional hazards models were applied to identify mortality risk factors. Results: Candida auris was the most frequently isolated organism (n=1,102; fatality 33.9%), followed by Klebsiella pneumoniae (n=849; 41.1%), Acinetobacter spp. (n=574; 41.6%), and Pseudomonas aeruginosa (n=357; 26.1%). Most isolates were multidrug-resistant (MDR) (n=2,037; mortality 33.8%). High-mortality resistance patterns included CRKP (42.1%), ESBL (32.4%), XDR (35.7%), VRE (59.1%), and PDR (75.0%). Overall mortality was 32.5%. Mortality was significantly higher among geriatric patients (43.9%, p=0.001), females (35.6%, p=0.001), and bedridden individuals (50.0%, p=0.040). Gram-negative and fungal infections were associated with higher mortality than gram-positive or viral outbreaks (p < 0.001). Device-related outbreaks, particularly CLABSI (44.9%) and VAE (45.7%), had higher mortality than CAUTI (30.0%) or non-device outbreaks (30.4%) (p=0.001). Cox regression identified increasing age (HR=1.004), class A outbreaks (HR=1.460), and transfer from other departments (HR=1.238) as significant mortality predictors. Protective factors included absence of a device (HR=0.768), IV medications intake (HR=0.391), chest tube insertion (HR=0.661), shorter ICU stay (HR=0.985), and male gender (HR=0.830). Conclusion: Outbreak-related HAIs remain associated with substantial mortality in Saudi healthcare settings. Early referral and ICU management improve survival. Strengthening infection prevention, antimicrobial stewardship, and broad-spectrum pathogen surveillance is critical to reducing outbreak-associated mortality.

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