Evolving Patterns of Etiological Profiles and Susceptibility Trends of Healthcare-Associated Infections Since Inception: A Meta-Analysis

Over six decades, global surveillance has revealed major shifts in healthcare-associated infections and antimicrobial resistance. Synthesizing data from multicontinental studies spanning 1992-2021, early reports showed balanced Gram-positive and Gram-negative pathogens with rising methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Subsequent findings indicated a shift toward multidrug-resistant Enterobacterales, persistent ICU non-fermenters, and emerging Candida auris, alongside declining MRSA and Clostridioides difficile rates but increasing carbapenem resistance in Klebsiella pneumoniae and Acinetobacter baumannii. Low- and middle-income countries reported higher infection rates and greater Gram-negative burdens. Overall, infections have transitioned from staphylococcal dominance to multidrug-resistant Gram-negative pathogens and fungi, highlighting the need for locally tailored infection control, rapid diagnostics, and stewardship strategies.