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Background  Despite being largely preventable, surgical site infections (SSIs) are still one of the most frequent healthcare-associated infections. The presence of resistant pathogens can further augment their clinical and economic impacts. The objective was to estimate the distribution and resistance in SSI pathogens in Saudi Arabia and to compare them to the US National Healthcare Safety Network (NHSN) hospitals.    Methods  Targeted SSI surveillance was prospectively conducted on several surgical procedures done between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of SSI and bacterial resistance were based on NHSN.    Results  A total 492 pathogens causing 403 SSI events were included. The most frequent pathogens were  Staphylococcus aureus  (22.8%),  Pseudomonas aeruginosa  (20.1%),  Klebsiella  spp. (12.2%), and  Escherichia coli  (12.2%), with marked variability between surgeries. Approximately 30.3% of  Staphylococcus aureus  was methicillin-resistant (MRSA), 13.0% of  Enterococcus  spp. was vancomycin-resistant (VRE), and 5.5% of  Enterobacteriaceae  were carbapenem resistant (CRE). The highest multidrug-resistant (MDR) GNPs were  Acinetobacter  spp. (58.3%),  Klebsiella  spp. (20.4%) and  Escherichia coli  (16.3%). MRSA was significantly less frequent while cephalosporin-resistant  Klebsiella  spp., MDR  Klebsiella  spp., and MDR  Escherichia coli  were significantly more frequent in our hospitals compared with NHSN hospitals.    Conclusion  GNPs in a tertiary care setting in Saudi Arabia are responsible for more than 60% of SSI with more resistant patterns than Western countries. This information may be critical to secure resources and ensure support for caregivers and healthcare leaders in implementing antimicrobial stewardship programs and evidence-based SSI preventive practices.

bmc infectious diseases

High contribution and impact of resistant gram negative pathogens causing surgical site infections at a multi-hospital healthcare system in Saudi Arabia, 2007–2016