Evolving landscape of respiratory infections and AMR in the UAE: A 12-year nationwide study of regional burden, epidemiologic trends and policy implications

OBJECTIVES: This study characterizes the epidemiological trends and resistance profiles of respiratory tract infections (RTIs) in the United Arab Emirates (UAE) from 2010 to 2022, aiming to inform national control strategies. METHOD: We conducted a retrospective observational study of RTI cases across 345 UAE healthcare settings using data from the national surveillance network. Pathogen identification and resistance profiling were performed using advanced diagnostics and standardized antimicrobial susceptibility testing, in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: Lower respiratory tract infections (LRI) comprised most cases (73.1%; n = 100,856), including 6416 due to Mycobacterium tuberculosis, while upper respiratory infections made up 26.9%. LRI incidence was stable until 2014 but rose significantly from 2015 to 2022 (AAPC = 1.58; 95% CI: 1.58-3.87), especially in the Northern Emirates. Carbapenem resistance among Enterobacterales was 22.5% (14.4% in K. pneumoniae), and third-generation cephalosporin resistance 30.1% (62.3% in E. coli). Resistance was highest in A. baumannii (61%) and P. aeruginosa (27.4%). Macrolide and MRSA resistance increased significantly. The majority (85%) of tuberculosis cases were identified among individuals from South Asian and East African regions, with a post-COVID surge, while drug resistance remained below 15%. CONCLUSION: These findings underscore the urgent need for regionally tailored infection control strategies, enhanced antimicrobial stewardship, and expanded pathogen surveillance to prevent further escalation of AMR.