Epidemiology, clinical outcomes, and antimicrobial resistance of bloodstream infections: a 13-year nationwide multicenter study from the United Arab Emirates

Bloodstream infections (BSIs) remain a major cause of hospital admission and death worldwide. We describe the epidemiology, outcomes, and resistance patterns of BSIs across the United Arab Emirates over 13 years, filling a critical data gap in the Gulf region. We analyzed 50,457 unique BSI isolates collected between 2010 and 2022 from hospitals, centers, and clinics across all seven Emirates. We assessed pathogen distribution, acquisition source, AMR, multidrug resistance (MDR), and clinical outcomes. Multivariable logistic regression examined associations between pathogens and severe outcomes. We identified a dual burden of severe BSI concentrated at the extremes of age. Adults aged ≥ 55 years accounted for 39.7% of cases and had frequent hospital acquisition (52.4%) and the highest mortality (31.7%). Among children under 1 year old, we observed the highest ICU admission rate (43.6%), compared to 25.3% overall, and a high proportion of hospital-acquired infection (56.7%). Although overall BSI incidence remained stable, candidemia increased significantly over time, and Candida species showed the strongest association with ICU admission and death. Carbapenem resistance was high in Acinetobacter baumannii (54.2%) and Pseudomonas aeruginosa (27.8%), and present in 17.2% of K. pneumoniae . Third-generation cephalosporin resistance affected nearly half of E. coli (47.3%) and 41.2% of K. pneumoniae. MDR infection was associated with significantly longer hospital stay and was concentrated in hospital-acquired cases and critical care settings. We provide the first population-level epidemiological benchmark for BSI in the UAE. Despite relatively stable BSI incidence, the UAE faces a growing burden of candidemia and antimicrobial resistance, with severe outcomes concentrated among neonates and older adults.