Early View Articles
Resistance Patterns of Gram-Negative Bacteria and Surgical Site Infections Across the Middle East: A Systematic Review and Meta-Analysis
Meer Kamal, Mohammad Al-Tamimi, Ayman D. Alsheikh, Imdat Kilbas, Khaled M. Aboshanab, Muhammad Yasir, Mutasim E. Ibrahim, Shnya R. Hamalaw and 6 more
IntroductionSurgical site infections (SSIs) are a leading healthcare-associated infection, driven by multidrug-resistant Gram-negative bacteria. Regional data from the Middle East remain limited. This meta-analysis aimed to estimate pooled antimicrobial resistance (AMR) profiles of Gram-negative isolates (GNI) recovered from SSIs.
MethodsPubMed/MEDLINE and Google Scholar were searched in January 2026 for studies reporting AMR in SSI GNI. Eligible studies were English-language reports from the Middle East presenting AMR patterns of Gram-negative bacteria recovered from SSIs. Case reports, laboratory and animal studies, conference papers, and abstract-only publications were ineligible. Proportions were pooled using DerSimonian-Laird random-effects models with Freeman-Tukey double-arcsine transformation, heterogeneity assessed by I².
ResultsTwenty-three studies from 8 countries were included. GNI comprised 71.9% (95% CI 60.5-82.2) of all culture-positive isolates and, when restricted to SSI-confirmed specimens, 86.4% (95% CI 63.6-99.3). Escherichia coli was most frequent (27.9%), followed by Pseudomonas aeruginosa (25.8%) and Klebsiella pneumoniae (21.3%). Resistance exceeded 65% for ampicillin in E. coli and for ceftriaxone in both E. coli and K. pneumoniae, with resistance to the remaining third-generation cephalosporins (cefotaxime, ceftazidime) ranging from 46.5% to 85.9%.
ConclusionGram-negative SSI isolates in the Middle East showed high resistance across many agent classes, with substantial multidrug resistance, carbapenem resistance, and ESBL production. This regional resistance profile reinforces the need for local, SSI-specific surveillance and antimicrobial stewardship.
Keywords Surgical site infection
· Antimicrobial resistance
· Gram-negative bacteria
· Multidrug resistance
· Middle East
All subjects
